Control program adaptation based on device status and user input

ABSTRACT

A surgical system comprising a surgical instrument, a generator configured to supply power to an end effector, and a processor configured to run a control program to operate the surgical system is disclosed. The surgical instrument comprises the end effector which includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is moved with respect to one another between an open position and a closed position. Tissue is configured to be positioned between the first jaw and the second jaw. The processor is configured to detect a first parameter of the surgical system, detect at least one user input, and modify the control program in response to the detected first parameter and the at least one user input.

CROSS REFERENCE TO RELATED APPLICATION

This non-provisional application claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application Ser. No. 62/955,299,entitled DEVICES AND SYSTEMS FOR ELECTROSURGERY, filed Dec. 30, 2019,the disclosure of which is incorporated by reference herein in itsentirety.

BACKGROUND

The present invention relates to surgical instruments designed to treattissue, including but not limited to surgical instruments that areconfigured to cut and fasten tissue. The surgical instruments mayinclude electrosurgical instruments powered by generators to effecttissue dissecting, cutting, and/or coagulation during surgicalprocedures. The surgical instruments may include instruments that areconfigured to cut and staple tissue using surgical staples and/orfasteners. The surgical instruments may be configured for use in opensurgical procedures, but have applications in other types of surgery,such as laparoscopic, endoscopic, and robotic-assisted procedures andmay include end effectors that are articulatable relative to a shaftportion of the instrument to facilitate precise positioning within apatient.

SUMMARY

In various embodiments, a surgical system comprising a surgicalinstrument, a generator configured to supply power to an end effector,and a processor configured to run a control program to operate thesurgical system is disclosed. The surgical instrument comprises the endeffector which includes a first jaw and a second jaw. At least one ofthe first jaw and the second jaw is moved with respect to one anotherbetween an open position and a closed position. Tissue is configured tobe positioned between the first jaw and the second jaw. The processor isconfigured to detect a first parameter of the surgical system, detect atleast one user input, and modify the control program in response to thedetected first parameter and the at least one user input.

In various embodiments, a surgical system comprising a surgicalinstrument, a generator configured to supply power to the surgicalinstrument, and a processor configured to run a control program tooperate the surgical system is disclosed. The processor is configured todetect a status of the surgical instrument, detect at least one userinput, and adapt the control program in response to the detected statusof the surgical instrument and the at least one user input.

In various embodiments, a surgical system comprising a surgicalinstrument, a generator configured to supply power to an end effector,and a processor configured to run a control program to operate thesurgical system is disclosed. The surgical instrument comprises the endeffector which includes a first jaw and a second jaw. At least one ofthe first jaw and the second jaw is moved with respect to one anotherbetween an open position and a closed position. Tissue is configured tobe positioned between the first jaw and the second jaw. The processor isconfigured to detect a first parameter of the surgical instrument,detect a second parameter of the generator, detect at least one userinput, and modify the control program in response to the detected firstparameter, the detected second parameter, and the at least one userinput.

FIGURE DESCRIPTIONS

The novel features of the various aspects are set forth withparticularity in the appended claims. The described aspects, however,both as to organization and methods of operation, may be best understoodby reference to the following description, taken in conjunction with theaccompanying drawings in which:

FIG. 1 illustrates an example of a generator for use with a surgicalsystem, in accordance with at least one aspect of the presentdisclosure;

FIG. 2 illustrates one form of a surgical system comprising a generatorand an electrosurgical instrument usable therewith, in accordance withat least one aspect of the present disclosure;

FIG. 3 illustrates a schematic diagram of a surgical instrument or tool,in accordance with at least one aspect of the present disclosure;

FIG. 4 is a perspective view of a surgical system comprising a surgicalinstrument and a display monitor, wherein the surgical instrumentcomprises a display screen in accordance with at least one embodiment;

FIG. 5 is a schematic representation of the corresponding views of thedisplay screen of the surgical instrument and the display monitor ofFIG. 4 in accordance with at least one embodiment;

FIG. 6 is a schematic representation of the corresponding views of thedisplay screen of the surgical instrument and the display monitor ofFIG. 4 in accordance with at least one embodiment;

FIG. 7 is a schematic representation of the corresponding views of thedisplay screen of the surgical instrument and the display monitor ofFIG. 4 in accordance with at least one embodiment;

FIG. 8 is a schematic representation of the corresponding views of thedisplay screen of the surgical instrument and the display monitor ofFIG. 4 in accordance with at least one embodiment;

FIG. 9 is a schematic representation of the corresponding views of thedisplay screen of the surgical instrument and the display monitor ofFIG. 4 in accordance with at least one embodiment;

FIG. 10 is a graphical depiction of the relationship between the totaleffective energy delivered by one or more generators of a surgicalsystem and a duty cycle of a motor from a smoke evacuator in accordancewith at least one embodiment;

FIG. 11 is a schematic representation of a surgical system comprising asurgical hub, a combination electrosurgical instrument powered by aplurality of generators, a smoke evacuation system, and a display inaccordance with at least one embodiment;

FIG. 12 is a graphical depiction of the relationship between the powersupplied by one or more generators of a surgical system over time andthe impedance of treated tissue over time in accordance with at leastone embodiment;

FIG. 13 is a schematic representation of the communication pathways witha surgical system, wherein the surgical system comprises a surgical hub,a smoke evacuation device, a surgical instrument, a first generatorconfigured to power a first operation of the surgical instrument, and asecond generator configured to power a second operation of the surgicalinstrument in accordance with at least one embodiment;

FIG. 14 is a schematic representation of a surgical system comprising asurgical hub and a plurality of robotic arms configured to receive toolsthereon, wherein the surgical system comprises an authentication moduleconfigured to approve the tools for attachment to and/or use with thesurgical system in accordance with at least one embodiment;

FIG. 15 is a schematic representation of a surgical system positionedwithin a treatment room in accordance with at least one embodiment;

FIG. 16 is a chart depicting various operational parameters and/orspecifications of a surgical instrument at various stages of a surgicalprocedure in accordance with at least one embodiment;

FIG. 17 is an elevational view of the surgical instrument of FIG. 16shown at a first time delivering bipolar energy to patient tissue;

FIG. 18 is an elevational view of the surgical instrument of FIG. 16shown at a second time delivering bipolar and monopolar energies topatient tissue;

FIG. 19 is an elevational view of the surgical instrument of FIG. 16shown at a fourth time delivering monopolar energy to patient tissue;

FIG. 20 is a graphical representation of various operational parametersand/or specifications of the surgical instrument of FIG. 16 at variousstages of the surgical procedure;

FIG. 21 is a graphical representation of measured tissue impedance overa duration of a surgical procedure in accordance with at least oneembodiment;

FIG. 22 is a schematic representing a strain calculation, wherein theapplied strain is calculated using a gap defined between jaws of an endeffector when the end effector is in an open configuration in accordancewith at least one embodiment;

FIG. 23 is a schematic representing the strain calculation of FIG. 22,wherein the calculated applied strain overestimates an actual appliedstrain as the patient tissue is not in contact with positioned betweenthe jaws of the end effector;

FIG. 24 is a schematic representing a tissue impedance calculation,wherein the tissue impedance is calculated using a gap defined betweenthe jaws of the end effector when the jaws of the end effector contactthe patient tissue positioned therebetween in accordance with at leastone embodiment;

FIG. 25 is a graphical representation of a relationship between motorcurrent and jaw gap over time in accordance with at least oneembodiment;

FIG. 26 is a schematic representation of a network formed by surgicalinstruments and a cloud-based storage medium in accordance with at leastone embodiment;

FIG. 27 is a graphical representation of a relationship between a changein jaw gap and jaw motor clamp current determined from the network ofFIG. 26;

FIG. 28 is a graphical representation of a relationship betweengenerator power over time determined from the network of FIG. 26;

FIG. 29 is a graphical representation of a relationship betweenactivation cycles of a surgical instrument and a measured impedance whenan end effector of the surgical instrument is in a closed configurationwithout patient tissue positioned therebetween in accordance with atleast one embodiment;

FIG. 30 is a graphical representation of the relationships betweentissue conductance, jaw aperture dimension, and jaw motor force during ajaw clamp stroke in accordance with at least one embodiment; and

FIG. 31 is a graphical representation of a jaw closure speed based on auser input and the jaw closure speed based on the user input and amonitored parameter in accordance with at least one embodiment.

DESCRIPTION

Applicant of the present application owns the following U.S. PatentApplications that were filed on even date herewith and which are eachherein incorporated by reference in their respective entireties:

Attorney Docket No. END9234USNP1/190717-1M, entitled METHOD FOR ANELECTROSURGICAL PROCEDURE;

Attorney Docket No. END9234USNP2/190717-2, entitled ARTICULATABLESURGICAL INSTRUMENT;

Attorney Docket No. END9234USNP3/190717-3, entitled SURGICAL INSTRUMENTWITH JAW ALIGNMENT FEATURES;

Attorney Docket No. END9234USNP4/190717-4, entitled SURGICAL INSTRUMENTWITH ROTATABLE AND ARTICULATABLE SURGICAL END EFFECTOR;

Attorney Docket No. END9234USNP5/190717-5, entitled ELECTROSURGICALINSTRUMENT WITH ASYNCHRONOUS ENERGIZING ELECTRODES;

Attorney Docket No. END9234USNP6/190717-6, entitled ELECTROSURGICALINSTRUMENT WITH ELECTRODES BIASING SUPPORT;

Attorney Docket No. END9234USNP7/190717-7, entitled ELECTROSURGICALINSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES;

Attorney Docket No. END9234USNP8/190717-8, entitled ELECTROSURGICALINSTRUMENT WITH VARIABLE CONTROL MECHANISMS;

Attorney Docket No. END9234USNP9/190717-9, entitled ELECTROSURGICALSYSTEMS WITH INTEGRATED AND EXTERNAL POWER SOURCES;

Attorney Docket No. END9234USNP10/190717-10, entitled ELECTROSURGICALINSTRUMENTS WITH ELECTRODES HAVING ENERGY FOCUSING FEATURES;

Attorney Docket No. END9234USNP11/190717-11, entitled ELECTROSURGICALINSTRUMENTS WITH ELECTRODES HAVING VARIABLE ENERGY DENSITIES;

Attorney Docket No. END9234USNP12/190717-12, entitled ELECTROSURGICALINSTRUMENT WITH MONOPOLAR AND BIPOLAR ENERGY CAPABILITIES;

Attorney Docket No. END9234USNP13/190717-13, entitled ELECTROSURGICALEND EFFECTORS WITH THERMALLY INSULATIVE AND THERMALLY CONDUCTIVEPORTIONS;

Attorney Docket No. END9234USNP14/190717-14, entitled ELECTROSURGICALINSTRUMENT WITH ELECTRODES OPERABLE IN BIPOLAR AND MONOPOLAR MODES;

Attorney Docket No. END9234USNP15/190717-15, entitled ELECTROSURGICALINSTRUMENT FOR DELIVERING BLENDED ENERGY MODALITIES TO TISSUE;

Attorney Docket No. END9234USNP17/190717-17, entitled CONTROL PROGRAMFOR MODULAR COMBINATION ENERGY DEVICE; and

Attorney Docket No. END9234USNP18/190717-18, entitled SURGICAL SYSTEMCOMMUNICATION PATHWAYS.

Applicant of the present application owns the following U.S. ProvisionalPatent Applications that were filed on Dec. 30, 2019, the disclosure ofeach of which is herein incorporated by reference in its entirety:

U.S. Provisional Patent Application Ser. No. 62/955,294, entitled USERINTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATION ENERGY MODALITYEND-EFFECTOR;

U.S. Provisional Patent Application Ser. No. 62/955,292, entitledCOMBINATION ENERGY MODALITY END-EFFECTOR; and

U.S. Provisional Patent Application Ser. No. 62/955,306, entitledSURGICAL INSTRUMENT SYSTEMS.

Applicant of the present application owns the following U.S. PatentApplications, the disclosure of each of which is herein incorporated byreference in its entirety:

U.S. patent application Ser. No. 16/209,395, titled METHOD OF HUBCOMMUNICATION, now U.S. Patent Application Publication No. 2019/0201136;

U.S. patent application Ser. No. 16/209,403, titled METHOD OF CLOUDBASED DATA ANALYTICS FOR USE WITH THE HUB, now U.S. Patent ApplicationPublication No. 2019/0206569;

U.S. patent application Ser. No. 16/209,407, titled METHOD OF ROBOTICHUB COMMUNICATION, DETECTION, AND CONTROL, now U.S. Patent ApplicationPublication No. 2019/0201137;

U.S. patent application Ser. No. 16/209,416, titled METHOD OF HUBCOMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS, now U.S. PatentApplication Publication No. 2019/0206562;

U.S. patent application Ser. No. 16/209,423, titled METHOD OFCOMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLYDISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS, now U.S. PatentApplication Publication No. 2019/0200981;

U.S. patent application Ser. No. 16/209,427, titled METHOD OF USINGREINFORCED FLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO OPTIMIZEPERFORMANCE OF RADIO FREQUENCY DEVICES, now U.S. Patent ApplicationPublication No. 2019/0208641;

U.S. patent application Ser. No. 16/209,433, titled METHOD OF SENSINGPARTICULATE FROM SMOKE EVACUATED FROM A PATIENT, ADJUSTING THE PUMPSPEED BASED ON THE SENSED INFORMATION, AND COMMUNICATING THE FUNCTIONALPARAMETERS OF THE SYSTEM TO THE HUB, now U.S. Patent ApplicationPublication No. 2019/0201594;

U.S. patent application Ser. No. 16/209,447, titled METHOD FOR SMOKEEVACUATION FOR SURGICAL HUB, now U.S. Patent Application Publication No.2019/0201045;

U.S. patent application Ser. No. 16/209,453, titled METHOD FORCONTROLLING SMART ENERGY DEVICES, now U.S. Patent ApplicationPublication No. 2019/0201046;

U.S. patent application Ser. No. 16/209,458, titled METHOD FOR SMARTENERGY DEVICE INFRASTRUCTURE, now U.S. Patent Application PublicationNo. 2019/0201047;

U.S. patent application Ser. No. 16/209,465, titled METHOD FOR ADAPTIVECONTROL SCHEMES FOR SURGICAL NETWORK CONTROL AND INTERACTION, now U.S.Patent Application Publication No. 2019/0206563;

U.S. patent application Ser. No. 16/209,478, titled METHOD FORSITUATIONAL AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK CONNECTEDDEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED SITUATION ORUSAGE, now U.S. Patent Application Publication No. 2019/0104919;

U.S. patent application Ser. No. 16/209,490, titled METHOD FOR FACILITYDATA COLLECTION AND INTERPRETATION, now U.S. Patent ApplicationPublication No. 2019/0206564;

U.S. patent application Ser. No. 16/209,491, titled METHOD FOR CIRCULARSTAPLER CONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL AWARENESS, nowU.S. Patent Application Publication No. 2019/0200998;

U.S. patent application Ser. No. 16/562,123, titled METHOD FORCONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLEDEVICES;

U.S. patent application Ser. No. 16/562,135, titled METHOD FORCONTROLLING AN ENERGY MODULE OUTPUT;

U.S. patent application Ser. No. 16/562,144, titled METHOD FORCONTROLLING A MODULAR ENERGY SYSTEM USER INTERFACE; and

U.S. patent application Ser. No. 16/562,125, titled METHOD FORCOMMUNICATING BETWEEN MODULES AND DEVICES IN A MODULAR SURGICAL SYSTEM.

Before explaining various aspects of an electrosurgical system indetail, it should be noted that the illustrative examples are notlimited in application or use to the details of construction andarrangement of parts illustrated in the accompanying drawings anddescription. The illustrative examples may be implemented orincorporated in other aspects, variations, and modifications, and may bepracticed or carried out in various ways. Further, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the illustrative examples for theconvenience of the reader and are not for the purpose of limitationthereof. Also, it will be appreciated that one or more of thefollowing-described aspects, expressions of aspects, and/or examples,can be combined with any one or more of the other following-describedaspects, expressions of aspects, and/or examples.

Various aspects are directed to electrosurgical systems that includeelectrosurgical instruments powered by generators to effect tissuedissecting, cutting, and/or coagulation during surgical procedures. Theelectrosurgical instruments may be configured for use in open surgicalprocedures, but has applications in other types of surgery, such aslaparoscopic, endoscopic, and robotic-assisted procedures.

As described below in greater detail, an electrosurgical instrumentgenerally includes a shaft having a distally-mounted end effector (e.g.,one or more electrodes). The end effector can be positioned against thetissue such that electrical current is introduced into the tissue.Electrosurgical instruments can be configured for bipolar or monopolaroperation. During bipolar operation, current is introduced into andreturned from the tissue by active and return electrodes, respectively,of the end effector. During monopolar operation, current is introducedinto the tissue by an active electrode of the end effector and returnedthrough a return electrode (e.g., a grounding pad) separately located ona patient's body. Heat generated by the current flowing through thetissue may form hemostatic seals within the tissue and/or betweentissues and thus may be particularly useful for sealing blood vessels,for example.

FIG. 1 illustrates an example of a generator 900 configured to delivermultiple energy modalities to a surgical instrument. The generator 900provides RF and/or ultrasonic signals for delivering energy to asurgical instrument. The generator 900 comprises at least one generatoroutput that can deliver multiple energy modalities (e.g., ultrasonic,bipolar or monopolar RF, irreversible and/or reversible electroporation,and/or microwave energy, among others) through a single port, and thesesignals can be delivered separately or simultaneously to an end effectorto treat tissue. The generator 900 comprises a processor 902 coupled toa waveform generator 904. The processor 902 and waveform generator 904are configured to generate a variety of signal waveforms based oninformation stored in a memory coupled to the processor 902, not shownfor clarity of disclosure. The digital information associated with awaveform is provided to the waveform generator 904 which includes one ormore DAC circuits to convert the digital input into an analog output.The analog output is fed to an amplifier 906 for signal conditioning andamplification. The conditioned and amplified output of the amplifier 906is coupled to a power transformer 908. The signals are coupled acrossthe power transformer 908 to the secondary side, which is in the patientisolation side. A first signal of a first energy modality is provided tothe surgical instrument between the terminals labeled ENERGY₁ andRETURN. A second signal of a second energy modality is coupled across acapacitor 910 and is provided to the surgical instrument between theterminals labeled ENERGY₂ and RETURN. It will be appreciated that morethan two energy modalities may be output and thus the subscript “n” maybe used to designate that up to n ENERGY_(n) terminals may be provided,where n is a positive integer greater than 1. It also will beappreciated that up to “n” return paths RETURN_(n) may be providedwithout departing from the scope of the present disclosure.

A first voltage sensing circuit 912 is coupled across the terminalslabeled ENERGY₁ and the RETURN path to measure the output voltagetherebetween. A second voltage sensing circuit 924 is coupled across theterminals labeled ENERGY₂ and the RETURN path to measure the outputvoltage therebetween. A current sensing circuit 914 is disposed inseries with the RETURN leg of the secondary side of the powertransformer 908 as shown to measure the output current for either energymodality. If different return paths are provided for each energymodality, then a separate current sensing circuit should be provided ineach return leg. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to respective isolation transformers 928,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 916. The outputs of the isolationtransformers 916, 928, 922 on the primary side of the power transformer908 (non-patient isolated side) are provided to a one or more ADCcircuit 926. The digitized output of the ADC circuit 926 is provided tothe processor 902 for further processing and computation. The outputvoltages and output current feedback information can be employed toadjust the output voltage and current provided to the surgicalinstrument and to compute output impedance, among other parameters.Input/output communications between the processor 902 and patientisolated circuits is provided through an interface circuit 920. Sensorsalso may be in electrical communication with the processor 902 by way ofthe interface circuit 920.

In one aspect, the impedance may be determined by the processor 902 bydividing the output of either the first voltage sensing circuit 912coupled across the terminals labeled ENERGY₁/RETURN or the secondvoltage sensing circuit 924 coupled across the terminals labeledENERGY₂/RETURN by the output of the current sensing circuit 914 disposedin series with the RETURN leg of the secondary side of the powertransformer 908. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to separate isolations transformers 928,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 916. The digitized voltage and currentsensing measurements from the ADC circuit 926 are provided the processor902 for computing impedance. As an example, the first energy modalityENERGY₁ may be RF monopolar energy and the second energy modalityENERGY₂ may be RF bipolar energy. Nevertheless, in addition to bipolarand monopolar RF energy modalities, other energy modalities includeultrasonic energy, irreversible and/or reversible electroporation and/ormicrowave energy, among others. Also, although the example illustratedin FIG. 1 shows a single return path RETURN may be provided for two ormore energy modalities, in other aspects, multiple return pathsRETURN_(n) may be provided for each energy modality ENERGY_(n).

As shown in FIG. 1, the generator 900 comprising at least one outputport can include a power transformer 908 with a single output and withmultiple taps to provide power in the form of one or more energymodalities, such as ultrasonic, bipolar or monopolar RF, irreversibleand/or reversible electroporation, and/or microwave energy, amongothers, for example, to the end effector depending on the type oftreatment of tissue being performed. For example, the generator 900 candeliver energy with higher voltage and lower current to drive anultrasonic transducer, with lower voltage and higher current to drive RFelectrodes for sealing tissue, or with a coagulation waveform for spotcoagulation using either monopolar or bipolar RF electrosurgicalelectrodes. The output waveform from the generator 900 can be steered,switched, or filtered to provide the frequency to the end effector ofthe surgical instrument. In one example, a connection of RF bipolarelectrodes to the generator 900 output would be preferably locatedbetween the output labeled ENERGY₂ and RETURN. In the case of monopolaroutput, the preferred connections would be active electrode (e.g.,pencil or other probe) to the ENERGY₂ output and a suitable return padconnected to the RETURN output.

Additional details are disclosed in U.S. Patent Application PublicationNo. 2017/0086914, titled TECHNIQUES FOR OPERATING GENERATOR FORDIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS, which published on Mar. 30, 2017, which is hereinincorporated by reference in its entirety.

FIG. 2 illustrates one form of a surgical system 1000 comprising agenerator 1100 and various surgical instruments 1104, 1106, 1108 usabletherewith, where the surgical instrument 1104 is an ultrasonic surgicalinstrument, the surgical instrument 1106 is an RF electrosurgicalinstrument, and the multifunction surgical instrument 1108 is acombination ultrasonic/RF electrosurgical instrument. The generator 1100is configurable for use with a variety of surgical instruments.According to various forms, the generator 1100 may be configurable foruse with different surgical instruments of different types including,for example, ultrasonic surgical instruments 1104, RF electrosurgicalinstruments 1106, and multifunction surgical instruments 1108 thatintegrate RF and ultrasonic energies delivered simultaneously from thegenerator 1100. Although in the form of FIG. 2 the generator 1100 isshown separate from the surgical instruments 1104, 1106, 1108 in oneform, the generator 1100 may be formed integrally with any of thesurgical instruments 1104, 1106, 1108 to form a unitary surgical system.The generator 1100 comprises an input device 1110 located on a frontpanel of the generator 1100 console. The input device 1110 may compriseany suitable device that generates signals suitable for programming theoperation of the generator 1100. The generator 1100 may be configuredfor wired or wireless communication.

The generator 1100 is configured to drive multiple surgical instruments1104, 1106, 1108. The first surgical instrument is an ultrasonicsurgical instrument 1104 and comprises a handpiece 1105 (HP), anultrasonic transducer 1120, a shaft 1126, and an end effector 1122. Theend effector 1122 comprises an ultrasonic blade 1128 acousticallycoupled to the ultrasonic transducer 1120 and a clamp arm 1140. Thehandpiece 1105 comprises a trigger 1143 to operate the clamp arm 1140and a combination of the toggle buttons 1137, 1134 b, 1134 c to energizeand drive the ultrasonic blade 1128 or other function. The togglebuttons 1137, 1134 b, 1134 c can be configured to energize theultrasonic transducer 1120 with the generator 1100.

The generator 1100 also is configured to drive a second surgicalinstrument 1106. The second surgical instrument 1106 is an RFelectrosurgical instrument and comprises a handpiece 1107 (HP), a shaft1127, and an end effector 1124. The end effector 1124 compriseselectrodes in clamp arms 1145, 1142 b and return through an electricalconductor portion of the shaft 1127. The electrodes are coupled to andenergized by a bipolar energy source within the generator 1100. Thehandpiece 1107 comprises a trigger 1145 to operate the clamp arms 1145,1142 b and an energy button 1135 to actuate an energy switch to energizethe electrodes in the end effector 1124. The second surgical instrument1106 can also be used with a return pad to deliver monopolar energy totissue.

The generator 1100 also is configured to drive a multifunction surgicalinstrument 1108. The multifunction surgical instrument 1108 comprises ahandpiece 1109 (HP), a shaft 1129, and an end effector 1125. The endeffector 1125 comprises an ultrasonic blade 1149 and a clamp arm 1146.The ultrasonic blade 1149 is acoustically coupled to the ultrasonictransducer 1120. The handpiece 1109 comprises a trigger 1147 to operatethe clamp arm 1146 and a combination of the toggle buttons 11310, 1137b, 1137 c to energize and drive the ultrasonic blade 1149 or otherfunction. The toggle buttons 11310, 1137 b, 1137 c can be configured toenergize the ultrasonic transducer 1120 with the generator 1100 andenergize the ultrasonic blade 1149 with a bipolar energy source alsocontained within the generator 1100. Monopolar energy can be deliveredto the tissue in combination with, or separately from, the bipolarenergy.

The generator 1100 is configurable for use with a variety of surgicalinstruments. According to various forms, the generator 1100 may beconfigurable for use with different surgical instruments of differenttypes including, for example, the ultrasonic surgical instrument 1104,the RF electrosurgical instrument 1106, and the multifunction surgicalinstrument 1108 that integrates RF and ultrasonic energies deliveredsimultaneously from the generator 1100. Although in the form of FIG. 2,the generator 1100 is shown separate from the surgical instruments 1104,1106, 1108, in another form the generator 1100 may be formed integrallywith any one of the surgical instruments 1104, 1106, 1108 to form aunitary surgical system. As discussed above, the generator 1100comprises an input device 1110 located on a front panel of the generator1100 console. The input device 1110 may comprise any suitable devicethat generates signals suitable for programming the operation of thegenerator 1100. The generator 1100 also may comprise one or more outputdevices 1112. Further aspects of generators for digitally generatingelectrical signal waveforms and surgical instruments are described in USpatent application publication US-2017-0086914-A1, which is hereinincorporated by reference in its entirety.

FIG. 3 illustrates a schematic diagram of a surgical instrument or tool600 comprising a plurality of motor assemblies that can be activated toperform various functions. In the illustrated example, a closure motorassembly 610 is operable to transition an end effector between an openconfiguration and a closed configuration, and an articulation motorassembly 620 is operable to articulate the end effector relative to ashaft assembly. In certain instances, the plurality of motors assembliescan be individually activated to cause firing, closure, and/orarticulation motions in the end effector. The firing, closure, and/orarticulation motions can be transmitted to the end effector through ashaft assembly, for example.

In certain instances, the closure motor assembly 610 includes a closuremotor. The closure 603 may be operably coupled to a closure motor driveassembly 612 which can be configured to transmit closure motions,generated by the motor to the end effector, in particular to displace aclosure member to close to transition the end effector to the closedconfiguration. The closure motions may cause the end effector totransition from an open configuration to a closed configuration tocapture tissue, for example. The end effector may be transitioned to anopen position by reversing the direction of the motor.

In certain instances, the articulation motor assembly 620 includes anarticulation motor that be operably coupled to an articulation driveassembly 622 which can be configured to transmit articulation motions,generated by the motor to the end effector. In certain instances, thearticulation motions may cause the end effector to articulate relativeto the shaft, for example.

One or more of the motors of the surgical instrument 600 may comprise atorque sensor to measure the output torque on the shaft of the motor.The force on an end effector may be sensed in any conventional manner,such as by force sensors on the outer sides of the jaws or by a torquesensor for the motor actuating the jaws.

In various instances, the motor assemblies 610, 620 include one or moremotor drivers that may comprise one or more H-Bridge FETs. The motordrivers may modulate the power transmitted from a power source 630 to amotor based on input from a microcontroller 640 (the “controller”), forexample, of a control circuit 601. In certain instances, themicrocontroller 640 can be employed to determine the current drawn bythe motor, for example.

In certain instances, the microcontroller 640 may include amicroprocessor 642 (the “processor”) and one or more non-transitorycomputer-readable mediums or memory units 644 (the “memory”). In certaininstances, the memory 644 may store various program instructions, whichwhen executed may cause the processor 642 to perform a plurality offunctions and/or calculations described herein. In certain instances,one or more of the memory units 644 may be coupled to the processor 642,for example. In various aspects, the microcontroller 640 may communicateover a wired or wireless channel, or combinations thereof.

In certain instances, the power source 630 can be employed to supplypower to the microcontroller 640, for example. In certain instances, thepower source 630 may comprise a battery (or “battery pack” or “powerpack”), such as a lithium-ion battery, for example. In certaininstances, the battery pack may be configured to be releasably mountedto a handle for supplying power to the surgical instrument 600. A numberof battery cells connected in series may be used as the power source630. In certain instances, the power source 630 may be replaceableand/or rechargeable, for example.

In various instances, the processor 642 may control a motor driver tocontrol the position, direction of rotation, and/or velocity of a motorof the assemblies 610, 620. In certain instances, the processor 642 cansignal the motor driver to stop and/or disable the motor. It should beunderstood that the term “processor” as used herein includes anysuitable microprocessor, microcontroller, or other basic computingdevice that incorporates the functions of a computer's centralprocessing unit (CPU) on an integrated circuit or, at most, a fewintegrated circuits. The processor 642 is a multipurpose, programmabledevice that accepts digital data as input, processes it according toinstructions stored in its memory, and provides results as output. It isan example of sequential digital logic, as it has internal memory.Processors operate on numbers and symbols represented in the binarynumeral system.

In one instance, the processor 642 may be any single-core or multicoreprocessor such as those known under the trade name ARM Cortex by TexasInstruments. In certain instances, the microcontroller 620 may be an LM4F230H5QR, available from Texas Instruments, for example. In at leastone example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4FProcessor Core comprising an on-chip memory of 256 KB single-cycle flashmemory, or other non-volatile memory, up to 40 MHz, a prefetch buffer toimprove performance above 40 MHz, a 32 KB single-cycle SRAM, an internalROM loaded with StellarisWare® software, a 2 KB EEPROM, one or more PWMmodules, one or more QEI analogs, one or more 12-bit ADCs with 12 analoginput channels, among other features that are readily available for theproduct datasheet. Other microcontrollers may be readily substituted foruse with the surgical instrument 600. Accordingly, the presentdisclosure should not be limited in this context.

In certain instances, the memory 644 may include program instructionsfor controlling each of the motors of the surgical instrument 600. Forexample, the memory 644 may include program instructions for controllingthe closure motor and the articulation motor. Such program instructionsmay cause the processor 642 to control the closure and articulationfunctions in accordance with inputs from algorithms or control programsof the surgical instrument 600.

In certain instances, one or more mechanisms and/or sensors such as, forexample, sensors 645 can be employed to alert the processor 642 to theprogram instructions that should be used in a particular setting. Forexample, the sensors 645 may alert the processor 642 to use the programinstructions associated with closing and articulating the end effector.In certain instances, the sensors 645 may comprise position sensorswhich can be employed to sense the position of a closure actuator, forexample. Accordingly, the processor 642 may use the program instructionsassociated with closing the end effector to activate the motor of theclosure drive assembly 620 if the processor 642 receives a signal fromthe sensors 630 indicative of actuation of the closure actuator.

In some examples, the motors may be brushless DC electric motors, andthe respective motor drive signals may comprise a PWM signal provided toone or more stator windings of the motors. Also, in some examples, themotor drivers may be omitted and the control circuit 601 may generatethe motor drive signals directly.

It is common practice during various laparoscopic surgical procedures toinsert a surgical end effector portion of a surgical instrument througha trocar that has been installed in the abdominal wall of a patient toaccess a surgical site located inside the patient's abdomen. In itssimplest form, a trocar is a pen-shaped instrument with a sharptriangular point at one end that is typically used inside a hollow tube,known as a cannula or sleeve, to create an opening into the body throughwhich surgical end effectors may be introduced. Such arrangement formsan access port into the body cavity through which surgical end effectorsmay be inserted. The inner diameter of the trocar's cannula necessarilylimits the size of the end effector and drive-supporting shaft of thesurgical instrument that may be inserted through the trocar.

Regardless of the specific type of surgical procedure being performed,once the surgical end effector has been inserted into the patientthrough the trocar cannula, it is often necessary to move the surgicalend effector relative to the shaft assembly that is positioned withinthe trocar cannula in order to properly position the surgical endeffector relative to the tissue or organ to be treated. This movement orpositioning of the surgical end effector relative to the portion of theshaft that remains within the trocar cannula is often referred to as“articulation” of the surgical end effector. A variety of articulationjoints have been developed to attach a surgical end effector to anassociated shaft in order to facilitate such articulation of thesurgical end effector. As one might expect, in many surgical procedures,it is desirable to employ a surgical end effector that has as large arange of articulation as possible.

Due to the size constraints imposed by the size of the trocar cannula,the articulation joint components must be sized so as to be freelyinsertable through the trocar cannula. These size constraints also limitthe size and composition of various drive members and components thatoperably interface with the motors and/or other control systems that aresupported in a housing that may be handheld or comprise a portion of alarger automated system. In many instances, these drive members mustoperably pass through the articulation joint to be operably coupled toor operably interface with the surgical end effector. For example, onesuch drive member is commonly employed to apply articulation controlmotions to the surgical end effector. During use, the articulation drivemember may be unactuated to position the surgical end effector in anunarticulated position to facilitate insertion of the surgical endeffector through the trocar and then be actuated to articulate thesurgical end effector to a desired position once the surgical endeffector has entered the patient.

Thus, the aforementioned size constraints form many challenges todeveloping an articulation system that can effectuate a desired range ofarticulation, yet accommodate a variety of different drive systems thatare necessary to operate various features of the surgical end effector.Further, once the surgical end effector has been positioned in a desiredarticulated position, the articulation system and articulation jointmust be able to retain the surgical end effector in that position duringthe actuation of the end effector and completion of the surgicalprocedure. Such articulation joint arrangements must also be able towithstand external forces that are experienced by the end effectorduring use.

Various modes of one or more surgical devices are often used throughouta particular surgical procedure. Communication pathways extendingbetween the surgical devices and a centralized surgical hub can promoteefficiency and increase success of the surgical procedure, for example.In various instances, each surgical device within a surgical systemcomprises a display, wherein the display communicates a presence and/oran operating status of other surgical devices within the surgicalsystem. The surgical hub can use the information received through thecommunication pathways to assess compatibility of the surgical devicesfor use with one another, assess compatibility of the surgical devicesfor use during a particular surgical procedure, and/or optimizeoperating parameters of the surgical devices. As described in greaterdetail herein, the operating parameters of the one or more surgicaldevices can be optimized based on patient demographics, a particularsurgical procedure, and/or detected environmental conditions such astissue thickness, for example.

A divided display system is shown in FIGS. 4-9. The divided displaycommunicates various generator and/or surgical device parameters betweena display 27010 of a handheld surgical instrument 27000 and a primarymonitor display 27100. FIG. 4 depicts an example of the display 27010 ofthe handheld surgical instrument 27000. In various instances, thedisplay 27010 includes a touch-sensitive graphical user interfacecapable of receiving user inputs. The display 27010 comprises varioussettings and/or modes that allow a user to customize the informationand/or images shown on the display 27010 at any given time.

The surgical instrument 27000 is in communication with the main displaymonitor 27100. The main display monitor 27100 comprises a larger screenthan the display 27010 of the surgical instrument 27000. In variousinstances, the main display monitor 27100 displays the same informationand/or images as the display 27010 of the surgical instrument 27000. Inother instances, the main display monitor 27100 displays differentinformation and/or images than the display 27010 of the surgicalinstrument 27000. In various instances, the main display monitor 27100includes a touch-sensitive graphical user interface capable of receivinguser inputs. Similar to the display 27010 of the surgical instrument27000, the main display monitor 27100 comprises various settings and/ormodes that allow a user to customize the information and/or images shownon the main display monitor 27100 at any given time. As described ingreater detail herein, a selected mode on the main display monitor 27100can change the mode of the display 27010 on the surgical instrument27000 and vice versa. Stated another way, the main display monitor 27100and the surgical instrument display 27010 co-operate together tocommunicate the selected operational parameters most effectively to auser.

The depicted handheld surgical instrument 27000 comprises a combinationelectrosurgical functionality, wherein the surgical instrument 27000includes an end effector comprising a first jaw and a second jaw. Thefirst jaw and the second jaw comprise electrodes disposed thereon. Theelectrosurgical instrument 27000 comprises one or more power generatorsconfigured to supply power to the electrodes to energize the electrodes.More specifically, energy delivery to patient tissue supported betweenthe first jaw and the second jaw is achieved by energizing theelectrodes which are configured to deliver energy in a monopolar mode,bipolar mode, and/or a combination mode. The combination mode isconfigured to deliver alternating or blended bipolar and monopolarenergies. In at least one embodiment, the at least one power generatorcomprises a battery, a rechargeable battery, a disposable battery,and/or combinations thereof. Various details regarding the operation ofthe first and second generators is described in greater detail in U.S.patent application Ser. No. 16/562,123, titled METHOD FOR CONSTRUCTINGAND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES, andfiled on Sep. 5, 2019, which is hereby incorporated by reference in itsentirety.

The display 27010 of the surgical instrument 27000 and the main displaymonitor 27100 comprise divided displays to communicate numerousoperational parameters to a user. The divided displays are configured tobe selectively segmentable. Stated another way, a user is able to selectwhich operational parameters to display and/or where to display theselected operational parameters. Such customization minimizesdistraction by eliminating unwanted and/or unnecessary information whileallowing the user to efficiently observe the information needed and/ordesired to control the surgical instrument 27000 and/or to perform thesurgical procedure. The display 27010 of the surgical instrument 27000comprises a first portion 27012, wherein the power level of a particularmode is displayed. The display 27010 of the surgical instrument 27000further comprises a second portion 27014, wherein the mode that thesurgical instrument 27000 is in and/or the type of energy beingdelivered by the surgical instrument 27000 is identified, or otherwisecommunicated.

Similarly, the main display monitor 27100 comprises a segmented display;however, in various instances, the images displayed on the displaymonitor 27100 can be overlaid onto one another. A central portion 27110of the main display monitor 27100 streams a live feed and/or stillimages of a surgical site to the procedure room. The live feed and/orimages of the surgical site are captured through an appropriatelypositioned camera, such as an endoscope. A menu selection portion 27130of the main display monitor 27100 prompts and/or otherwise allows a userto select which mode the main display monitor 27100 is in and/or whatinformation a user wishes to see on the main display monitor 27100. Adevice status portion 27120 of the main display monitor 27100communicates information similar to the first portion 27012 of thesurgical instrument display 27010. In various instances, the devicestatus portion 27120 is further divided into multiple sections. Forexample, a first portion 27122 is configured to communicate an operatingparameter reflective of a bipolar mode. Such an operating parameter canbe specific and/or generic. A specific operating parameter can reflectthe power level of the bipolar mode, for example. A general operatingparameter can indicate whether the bipolar mode is active or inactive,for example. A second portion 27124 is configured to communicate anoperating parameter reflective of a monopolar mode. Such an operatingparameter can be specific and/or generic. A specific operating parametercan reflect the power level of the monopolar mode, for example. Ageneral operating parameter can indicate whether the monopolar mode isactive or inactive, for example. A third portion 27126 is configured tocommunicate an operating parameter reflective of a smoke evacuationsystem. Such an operating parameter can be specific and/or generic. Aspecific operating parameter can reflect the power level of the smokeevacuation system, for example. A general operating parameter canindicate whether the smoke evacuation system is active or inactive, forexample.

Referring now to FIGS. 5-9, the display 27010 of the surgical instrument27000 is shown alongside a corresponding display on the main displaymonitor 27100. As described in greater detail herein, as a user changesa power level on the handheld surgical instrument 27000, such a powerlevel change is reflected on the main display monitor 27100. Forexample, as shown in FIG. 5, a generator operating the bipolar mode iscurrently operating at a power level of 80 watts as indicated in thedevice status portion 27120 of the main display monitor 27100 and thefirst and second portions 27012, 27014 of the surgical instrumentdisplay 27010. More specifically, the first portion 27012 of thesurgical instrument display 27010 represents the output of a generatorwhile the second portion 27014 of the surgical instrument display 27010represents the mode and/or type of energy. Similarly, the device statusportion 27120 of the main display monitor 27100 indicates that agenerator is operating the bipolar energy mode at a power level of 80watts and a generator is operating the monopolar energy mode at a powerlevel of zero watts. Upon receiving a command to increase the poweroutput of the generator operating the bipolar mode to 100 watts, thesurgical instrument display 27010 and the main display monitor 27100change accordingly as shown in FIG. 6. More specifically, the firstportion 27012 of the surgical instrument display 27010 now representsthe power level of 100 watts, and the device status portion 27120 of themain display monitor 27100 now indicates that the generator is operatingthe bipolar mode at a power level of 100 watts. The main display monitor27100 continues to indicate that the monopolar energy mode is operatingat a power level of zero watts; however, the main display monitor 27100also indicates that the smoke detection system has been activated to 20%27126 due to the detection of smoke within the surgical site and/or theincreased power level of the surgical instrument.

FIGS. 7-9 depict the display 27010 of the surgical instrument 27000 andthe corresponding main display monitor 27100 when a combination of bothbipolar and monopolar energies are being delivered to patient tissue.FIG. 7 shows the first portion 27012′ of the surgical instrument display27010 in a total power mode. As shown on the main display monitor 27100,the bipolar energy mode 27122 is operating at a power level of 60 wattsand the monopolar energy model 27124 is operating at a power level of 60watts. However, a combined and/or total power level of 120 watts isrepresented on the first portion 27012′ of the surgical instrumentdisplay 27010. The main display monitor 27100 also indicates that thesmoke detection system has been activated to 50% 27126 due to thedetection of smoke within the surgical site and/or the increased powerlevel of the surgical instrument. As shown in FIG. 8, the user may wishto see the individual power levels of the bipolar mode and the monopolarmode on the first portion 27012″ of the surgical instrument display27010 and the total power level on the device status portion 27122′ ofthe main display monitor 27100. Stated another way, the informationshown on the displays in FIG. 8 are reversed from the displays shown inFIG. 7. The main display monitor 27100 further indicates that the smokedetection system has been activated to 73% 27126 due to the detection ofsmoke within the surgical site and/or the change of power levels of thebipolar and/or monopolar modes. The pair of displays shown in FIG. 9 aresimilar in many respects to the pair of displays shown in FIG. 8;however, the user has selected to remove the indication of the operatinglevel of the smoke detection system from the main display monitor 27100.

As discussed in greater detail herein, the surgical instrument display27010 and/or the main display monitor 27100 can comprise touch-sensitivegraphical user interfaces. In various instances, the surgical instrumentdisplay 27010 is used to control what is being displayed on the surgicalinstrument display 27010 versus what is being displayed on the maindisplay monitor 27100. In other instances, the main display monitor27100 is used to control what is being displayed on the surgicalinstrument display 27010 versus what is being displayed on the maindisplay monitor 27100. In various instances, each display is configuredto control what is displayed on its own display. In various instances,each display within a surgical system is configured to cooperativelycontrol what is displayed on other displays within the surgical system.

In various instances, a surgical system comprises an electrosurgicaldevice and a smoke evacuation system. As discussed in greater detailherein, the electrosurgical device is configured to deliver energy topatient tissue supported between the jaws of an end effector byenergizing electrodes. The electrodes are configured to deliver energyin a monopolar mode, bipolar mode, and/or a combination mode withalternating or blended bipolar and monopolar energies. In variousinstances, a first generator is configured to control the bipolar energymodality and a second generator is configured to control the monopolarenergy modality. A third generator is configured to control the smokeevacuation system. Various details regarding the operation of the firstand second generators is described in greater detail in U.S. patentapplication Ser. No. 16/562,123, titled METHOD FOR CONSTRUCTING ANDUSING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES, and filedon Sep. 5, 2019, which is hereby incorporated by reference in itsentirety.

FIG. 10 is a graphical representation 27200 depicting the proportionalrelationship between a duty cycle of the smoke evacuation system and thetotal effective energy delivered to patient tissue. Time 27210 isrepresented along the x-axis while power (W) 27220 a and duty cycle ofthe smoke evacuation system (%) 27220 b are represented along they-axis. The total effective energy is represented in three facets: (1)bipolar therapy 27230; (2) monopolar therapy 27240; and (3) combinedenergy 27250. The percentage of the smoke evacuator duty cycle isrepresented in two facets: (1) in response to the combined energy 27260;and (2) in response to only the bipolar therapy 27270. For example, attime t₀, power is not being delivered to the patient tissue and thesmoke evacuation system is inactive. At time t₁, bipolar therapy 27230is delivered at a first power level P₁. At time t₁, bipolar therapy27230 is the only energy delivered to the patient tissue. As the powerincreased to P₁ during the time period of t₀ to t₁, the smoke evacuationsystem activated. At time t₁, a first percentage S₁ of the smokeevacuation duty cycle is utilized.

At time t₂, the power level of the bipolar therapy 27230 increased andmonopolar therapy 27240 has begun to be delivered. At time t₃, thebipolar therapy 27230 decreased while the monopolar therapy 27240increased. Overall, the combined energy 27250 has remained substantiallythe same from t₂ to t₃. At time t₃, the combined energy 27250 isdelivered at a third power level P₃, which is higher than the firstpower level P₁ delivered at time t₁. As the power increased to P₃ duringthe time period of t₁ to t₃, the percentage of the smoke evacuationsystem duty cycle also increased. At time t₃, a third percentage S₃ ofthe smoke evacuation duty cycle is utilized. The third percentage S₃ isgreater than the first percentage S₁. At time t₄, delivery of thebipolar therapy 27230 has ceased and the only energy delivered to thepatient tissue is through monopolar therapy 27240. Notably, at time t₄,the monopolar therapy 27240 delivers energy to the patient tissue at thehighest level P₄ of monopolar therapy delivered during the entiresurgical procedure. Thus, as the delivered energy P₄ at time t₄ isgreater than the delivered energy P₃ at time t₃, the percentage of thesmoke evacuation duty cycle also increased. At time t₄, a fourthpercentage S₄ of the smoke evacuation duty cycle is utilized. The fourthpercentage S4 is greater than the third percentage S₃ and the firstpercentage S₁.

The graphical representation of FIG. 10 shows bipolar energy 27230 beingdelivered at varying levels throughout different time points of asurgical procedure. Such time points can correspond to a tissue sealingcycle in which the surgical hub commands the smoke evacuation system toincrease or decrease its operating level in response to the currentbipolar power level. After the tissue sealing cycle is complete,monopolar energy can be applied for a defined period of time in order tocut the patient tissue. As patient tissue is being cut, the surgical hubcan command the smoke evacuation system to increase its operating levelbased on the increase in energy being applied to cut the tissue as suchan increase in applied energy typically corresponds to an increase insmoke from burning tissue, for example. During the particular surgicalprocedure, the surgical hub is aware of pre-defined time points at whichthe energy delivery and power levels change. The pre-defined time pointscan vary based on the type of particular surgical procedure to beperformed, for example. The pre-defined time points can vary based onpatient demographics identified to the surgical hub, for example. Anydetected change in the type of energy being applied and/or the level ofenergy being applied can trigger responses of different components ofthe surgical system.

Similar to the surgical system described with respect to FIG. 10, asurgical system 27700 depicted in FIG. 11 comprises an electrosurgicalinstrument 27710 in communication with a surgical hub. Theelectrosurgical instrument 27710 is configured to deliver energy topatient tissue supported between the jaws of an end effector byelectrodes which are configured to deliver energy in a monopolar mode,bipolar mode, and/or a combination mode. The electrosurgical instrument27710 is configured to apply alternating or blended bipolar andmonopolar energies to the patient tissue when in the combination mode.The surgical system 27700 further comprises a first generator 27720configured to control the monopolar energy modality and a secondgenerator 27730 configured to control the bipolar energy modality. Adisplay screen 27750 is positioned in a location within a procedure roomthat is within a field of vision of a user. In various instances, theelectrosurgical instrument 27710 comprises a display positioned thereon.As the second generator 27730 causes bipolar energy to be delivered topatient tissue, the instrument display and/or the display screen 27750within the procedure room indicates the level of power being applied. Invarious instances, a level of smoke evacuation by the smoke evacuationsystem is indicated on the display(s), wherein the level of smokeevacuation is based on the level of power and/or type of energy beingapplied. As discussed in greater detail herein, when the first generator27720 causes monopolar energy to be delivered to patient tissue and/orthe second generator 27730 causes a reduced amount of bipolar energy tobe delivered to patient tissue, the display(s) are configured to updatethe displayed, or otherwise communicated, operational parameters. As thelevels of power change during the surgical procedure, such changes arecommunicated to the surgical hub. In response, the surgical hub isconfigured to automatically, or without an external prompt, alter thelevel of smoke evacuation to compensate for the changes in the level ofenergy and/or type of energy being applied to patient tissue.

At least one of the instrument display and the display screen 27750comprise a touch-sensitive graphical user interface which is configuredto receive a user input. The user is able to select what information isdisplayed, where the selected information is displayed on a particulardisplay, and/or which display within the surgical system displays thedesired information. In various instances, the surgical system 27700further comprises one or more cameras positioned within the procedureroom. The one or more cameras are configured to monitor movements of theuser and/or the devices of the surgical system. The one or more camerascan communicate any detected movement to the surgical hub, wherein thesurgical hub recognizes that the detected movement corresponds to apre-determined command. For example, a camera can detect when a userwaves an arm. A memory within the surgical hub correlates arm wavingwith the user's desire to clear the display of all operationalparameters, so that all that remains on the display is a live feedand/or images of the surgical site. Exemplary commands that can beassociated with a specific user and/or instrument movement includeadjusting a position of the display(s), adjusting the view of thedisplay(s), adjusting the information presented on the display(s),adjusting the location of the displayed information on a particulardisplay, adjusting the size of the displayed information, controllingpower levels of the generator(s), and/or controlling operationalparameters of various surgical instruments of the surgical system.

As discussed with respect to the surgical system 27700, theelectrosurgical instrument 27710 comprises a combination electricalmodality. A monopolar modality of the electrosurgical instrument isoperated by the first generator 27720, while a bipolar modality isoperated by a second generator 27730. Monopolar energy is delivered topatient tissue to make an incision, or otherwise cut the treated tissue.Prior to cutting the patient tissue, bipolar energy is delivered to thetissue in order to seal and/or cauterize the target tissue. A graphicalrepresentation 27300 of the power level (wattage) of the first generatorand the second generators 27320 a with respect to time (t) 27310 isshown in FIG. 12. The power level is represented in two facets: (1) ofthe first generator 27340; and (2) of the second generator 27330. Thegraphical representation 27300 further depicts the relationship oftissue impedance (Ω) 27320 b with respect to time (t) 27310. The tissueimpedance is represented in two facets (1) in response to the monopolarenergy delivered 27345; and (2) in response to the bipolar energydelivered 27335.

As the power level of the second generator 27330 increases from zero,bipolar energy is delivered to patient tissue. The impedance of thepatient tissue increases in response to the application of bipolarenergy 27335. Notably, the impedance of the patient tissue continues toincrease for an amount of time even after the power level of the secondgenerator 27330 begins to decrease. Stated another way, the impedance ofthe tissue sealed by the bipolar energy 27335 eventually decreases afterthe power level of the second generator 27330 is reduced absent thedelivery of monopolar energy to cut the patient tissue; however, theimpedance of the tissue in such instances does not necessarilyimmediately decrease. At time t₁, the power level of the first generator27340 increases, thereby cutting the tissue through delivery ofmonopolar energy to the patient tissue. The impedance of the patienttissue also increases in response to the application of monopolar energy27345. Notably, the impedance of the patient tissue exponentially growsas the tissue is cut and the power level of the first generator 27340decreases.

FIG. 13 depicts an algorithm 27400 for controlling various components ofa surgical system. The surgical system comprises a surgical instrumentconfigured to perform an intended surgical function. In variousinstances, the surgical instrument is handheld and comprises a handle. Auser is configured to operate various modes of the surgical instrumentthrough an input element on the handle. As described in greater detailherein, the surgical instrument comprises a first generator configuredto power a monopolar modality and a second generator configured to powera bipolar modality. The surgical system further comprises a smokeevacuation system configured to remove smoke and/or other unwantedparticulates from a surgical site. The surgical instrument and/or thesmoke evacuation system are in signal communication with a surgical hub,wherein the surgical hub is configured to orchestrate the appropriateresponse(s) of the components of the surgical system in response to auser input on the surgical instrument, the smoke evacuation system,and/or another component within the surgical system.

As shown in FIG. 13, a control algorithm 27400 begins when a userchanges a mode 27410 of the surgical instrument. For example, the usermay wish to increase the power level of the first generator to cutpatient tissue. In another example, the user may wish for the surgicalinstrument to seal and/or cut patient tissue. In any event, the surgicalinstrument then communicates 27412, 27414 the user input to the firstgenerator and the second generator, respectively. The surgicalinstrument further communicates 27415 the user input to the surgicalhub. After the surgical hub is informed 27420 of the desired increase inmonopolar energy, the surgical hub is configured to command the secondgenerator 27425 to supply and/or administer an appropriate power level.Upon receiving the communication 27412 from the surgical instrument, thefirst generator increases a waveform 27440 in preparation for cuttingpatient tissue. Upon receiving the communication 27414 from the surgicalinstrument and the command 27425 from the surgical hub, the secondgenerator increases the power level associated with the bipolar modality27450 in preparation for sealing the patient tissue after the cut isperformed. The second generator can then communicate 27455 its readinessto the first generator. The first generator is then able to startcutting the patient tissue 27442. Stated another way, the surgical hubprevents a monopolar electrode from being energized until the bipolarelectrode has been energized to prevent cutting of tissue that has notbeen cauterized and/or sealed. The surgical hub is further configured tocommand 27426 the smoke evacuation system to increase a motor rate inresponse to an increase in power levels of the first and secondgenerators. After the smoke evacuation system increases its motor rate27430, the smoke evacuation system is configured to maintain a line ofcommunication with the surgical hub, the surgical instrument, and/or thefirst and second generators throughout the duration of the surgicalprocedure. For example, the smoke evacuation system is configured tocontinuously communicate a current motor rate 27435 to the surgical hub.In such instances, the smoke evacuation system sends its current motorrate to the surgical hub every minute, or every two minutes; however,the smoke evacuation system is able to communicate its current motorrate at any suitable frequency. Upon the surgical instrument completingthe desired tissue cut, the user can once again provide an input on theinstrument handle to reduce the power level of the first generatorand/or end the control algorithm 27400. In various instances, thecontrol algorithm 27400 is configured to automatically reduce the powerlevel of the first generator after a pre-determined period of time thatcorresponds to a completion a tissue cut. Utilizing the controlalgorithm 27400, the surgical hub is able to orchestrate the operatingparameters of the components of the surgical system to facilitate anefficient and/or effective surgical procedure, for example.

Numerous surgical devices, tools, and/or replaceable components areoften used during a particular surgical procedure. Various systems aredisclosed herein that serve to, among other things, streamline thedevices and/or components that are stocked within a procedure room foruse during a particular procedure, minimize operator error, and/orminimize delays during surgical procedures. The systems described hereinincrease the efficiency of surgical procedures using, among otherthings, artificial intelligence and machine learning developed over thecourse of one or more surgical procedures.

Various components of an exemplary surgical system 27500 are shown inFIG. 14. During a particular surgical procedure, a patient rests on anoperating table, or any suitable procedure surface 27510. In variousinstances, the particular procedure is performed at least in part usinga surgical robot. The surgical robot comprises one or more robot arms27520. Each robot arm 27520 is configured to receive a tool component27590. The tool components 27590 are configured to cooperate with oneanother to perform and/or assist the clinician in performing theparticular surgical procedure. The tool components may comprise, forexample, a surgical stapling and/or tissue cutting tool component, atissue grasping tool component, and/or an electrosurgical toolcomponent. The tool components may comprise other distinguishingcharacteristics such as, for example, size, manufacturer, date ofmanufacture, number of previous uses, and/or expiration date.

The surgical system 27500 further comprises a surgical hub 27530.Various surgical hubs are described in described in U.S. patentapplication Ser. No. 16/209,395, titled METHOD OF HUB COMMUNICATION, andfiled on Dec. 4, 2018, which is hereby incorporated by reference in itsentirety. The surgical hub 27530 comprises a memory 27535 that storesvarious suitable, or otherwise appropriate, combinations of toolcomponents 27590 to be used during the particular procedure. Statedanother way, the memory 27535 of the surgical hub 27530 comprises astored information bank which can be used to indicate which toolcomponents 27590 are appropriate for utilization during a selectedprocedure.

Prior to performing a desired surgical procedure, a clinician cannotify, or otherwise communicate, details relating to the desiredsurgical procedure and/or the patient to the surgical hub 27530. Suchdetails can include, for example, an identity of the surgical procedure,an identity of the clinician performing the surgical procedure, and/or abiometric profile of the patient, for example. The surgical hub 27530 isthen configured to utilize one or more of the communicated details toevaluate and/or determine which tool components 27950 are necessaryand/or appropriate to perform the desired surgical procedure. In variousinstances, the surgical hub 27530 is configured to assess which modes ofeach tool components 27950 are appropriate for performing the desiredsurgical procedure on the particular patient.

As shown in FIG. 14, four robot arms 27250 surround, or are otherwiseattached to, the operating table 27510. Three tool components 27590 areconnected to three corresponding robot arms 27250, leaving one robot armfree to receive an additional tool component. A plurality of unique toolcomponents 27560, 27570, 27580 are shown stored on a moving stand 27550within the procedure room. As discussed above, the type and/orfunctionality of the tool components 27560, 27570, 27580 can bedifferent. In such instances, the surgical hub 27530 evaluates theavailable tool components 27560, 27570, 27580 and identifies anappropriate tool component for attachment to the surgical robot. Anappropriate tool component is identified based on one or more factorssuch as, which tool-type and/or function is still needed by the surgicalrobot and/or which tool component completes a pre-determined pairing oftool components that is associated with the desired surgical procedure,for example. In various instances, the surgical robot comprises a memorystoring pre-determined tool component pairings based on a particularsurgical procedure and/or a particular patient demographic, for example.In such instances, the surgical robot is able to identify an appropriatetool component for attachment to the surgical robot based on theidentity of the tool components already attached.

In other instances, the tool components 27560, 27570, 27580 comprise thesame type and/or functionality; however, the tool components 27560,27570, 27580 comprise at least one other distinguishing characteristicsuch as, for example, a difference in size, manufacturer, expirationdate, and/or number of previous uses. The surgical hub 27530 evaluates aprofile of each available tool component 27560, 27570, 27580 andidentifies an appropriate tool component based on which characteristicsare compatible with the profiles of the other selected and/or attachedtool components 27590.

As shown in FIG. 14, each tool component 27560, 27570, 27580 comprises aQR code 27565, 27575, 27585 positioned at any suitable location thereon,wherein each QR code contains a profile of information representative ofthe tool component to which the QR code is coupled. A user scans and/orreads the QR codes 27565, 27575, 27585 using any appropriate scanningtool 27540. The scanning tool 27540 then communicates the QR code and/orthe information contained within the QR code to the surgical hub 27530.In instances where the QR code itself is communicated by the scanningtool 27540 to the surgical hub 27530, a processor of the surgical hub27530 is configured to decrypt the profile of information contained bythe received QR code. While the depicted embodiment comprises QR codes,the tool components can comprise any suitable memory device such as abarcode, an RFID tag, and/or a memory chip, for example.

The surgical hub 27530 is configured to alert a user when a toolcomponent is not acceptable and/or desirable for use during the surgicalprocedure. Such an alert can be communicated through various forms offeedback, including, for example, haptic, acoustic, and/or visualfeedback. In at least one instance, the feedback comprises audiofeedback, and the surgical system 27500 can comprise a speaker whichemits a sound, such as a beep, for example, when an error is detected.In certain instances, the feedback comprises visual feedback and thetool components can each comprise a light emitting diode (LED), forexample, which flashes when an error is detected. In certain instances,the visual feedback can be communicated to a user through an alertpresented on a display monitor within a field of vision of theclinician. In various instances, the feedback comprises haptic feedbackand a component of the surgical system 27500 can comprise an electricmotor comprising an eccentric element which vibrates when an error isdetected. The alert can be specific or generic. For example, the alertcan specifically state that the QR code on the tool component is unableto be detected, or the alert can specifically state that the QR codecomprises information representative of an incompatible and/or defectivetool component.

For example, a user attempts to attach a first tool component 27560 tothe available robot arm 27590 of the surgical robot. Prior to attachingthe first tool component 27560 to the robot arm 27590, the scanning tool27540 scans the QR code 27565 displayed on the first tool component27560. The scanning tool 27540 communicates the QR code 27565 and/or theinformation contained within the QR code 27565 to the surgical hub27530. The surgical hub 27530 compares the information contained withinthe QR code 27565 to a stored list of acceptable tool componentsassociated with the particular surgical procedure and/or a stored listof acceptable tool components compatible with the tool components thatare currently attached to the surgical robot. In this instance, thesurgical hub 27530 fails to recognize and/or locate the first toolcomponent 27560 within its memory 27535. Thus, the first tool component27560 is not recommended and/or appropriate for use with the surgicalrobot. As discussed above, the surgical hub 27530 is configured to alertthe clinician of the incompatibility of the first tool component 27560with the surgical robot and/or the particular surgical procedure. Invarious instances, the surgical system 27500 can prevent the first toolcomponent 27560 from being attached thereto through a mechanical and/orelectrical lockout, for example. Such an attachment lockout prevents aclinician from missing and/or simply ignoring the alert issued by thesurgical system 27500. Stated another way, the attachment lockoutrequires the clinician to take affirmative steps in overriding the errorcommunicated by the surgical system 27500. In such instances, anoverride can be activated to allow the clinician to override any systemlockout and utilize operational functions of the first tool component27560. In various instances, an override is unavailable in order toprevent a clinician from utilizing the functionality of the first toolcomponent 27560 while the first tool component 27560 is recognized asincompatible for use with the surgical robot.

Similarly, a user attempts to attach a second tool component 27570 tothe available robot arm 27590 of the surgical robot. Prior to attachingthe second tool component 27570 to the robot arm 27590, the scanningtool 27540 scans the QR code 27575 displayed on the second toolcomponent 27570. The scanning tool 27540 communicates the QR code 27575and/or the information contained within the QR code 27575 to thesurgical hub 27530. The surgical hub 27530 compares the informationcontained within the QR code 27575 to a stored list of acceptable toolcomponents associated with the particular surgical procedure and/or astored list of acceptable tool components compatible with the toolcomponents that are currently attached to the surgical robot. In thisinstance, the surgical hub 27530 fails to recognize and/or locate thesecond tool component 27570 within its memory 27535. Thus, the secondtool component 27570 is not recommended and/or appropriate for use withthe surgical robot. As discussed above, the surgical hub 27530 isconfigured to alert the clinician of the incompatibility of the secondtool component 27570 with the surgical robot and/or the particularsurgical procedure. In various instances, the surgical system 27500 canprevent the second tool component 27570 from being attached thereto.Such an attachment lockout prevents a clinician from missing and/orsimply ignoring the alert issued by the surgical system 27500. Statedanother way, the attachment lockout requires the clinician to takeaffirmative steps in overriding the error communicated by the surgicalsystem 27500. In such instances, an override can be activated to allowthe clinician to override any system lockout and utilize operationalfunctions of the second tool component 27570. In various instances, anoverride is unavailable in order to prevent a clinician from utilizingthe functionality of the second tool component 27570 while the secondtool component 27570 is recognized as incompatible for use with thesurgical robot.

A user attempts to attach a third tool component 27580 to the availablerobot arm 27590 of the surgical robot. Prior to attaching the third toolcomponent 27580 to the robot arm 27590, the scanning tool 27540 scansthe QR code 27585 displayed on the third tool component 27580. Thescanning tool 27540 communicates the QR code 27585 and/or theinformation contained within the QR code 27585 to the surgical hub27530. The surgical hub 27530 compares the information contained withinthe QR code 27585 to a stored list of acceptable tool componentsassociated with the particular surgical procedure and/or a stored listof acceptable tool components compatible with the tool components thatare currently attached to the surgical robot. In this instance, thesurgical hub 27530 successfully recognizes and/or locates the third toolcomponent 27580 within its memory 27535. The third tool component 27580is then determined to be appropriate for use with the surgical robotduring the particular surgical procedure and/or with the other attachedtool components. In various instances, the surgical hub 27530 isconfigured to alert the clinician of the compatibility of the third toolcomponent 27580 with the surgical robot. In other instances, thesurgical system 27500 simply does not prevent the attachment of thethird tool component 27580 to the available robot arm 27590.

In various instances, the memory 27535 of the surgical hub 27530 isconfigured to store the QR codes associated with each tool componentused during a particular surgical procedure. The surgical hub 27530 canthen analyze the collected information to form observations and/orconclusions regarding factors such as, for example, the efficiencyand/or the effectiveness of a particular tool component and/or aplurality of tool components during a surgical procedure. Theobservations and/or conclusions can then be used by the surgical hub27530 in selecting and/or recommending which tool components to utilizeduring future surgical procedures.

FIG. 15 depicts a surgical system 27600 comprising one or more camerasconfigured to assist a clinician in performing an efficient and/orsuccessful surgical procedure. Similar to the surgical system 27500, thesurgical system 27600 comprises an operating table 27610, or anysuitable procedure surface. The surgical system 27600 further comprisesa surgical hub 27650, and a device tower 27660. Various surgical hubsare described in described in U.S. patent application Ser. No.16/209,395, titled METHOD OF HUB COMMUNICATION, and filed on Dec. 4,2018, which is hereby incorporated by reference in its entirety.

The surgical system 27600 further comprises a camera system includingone or more cameras 27640 positioned at various locations throughout theprocedure room. In the depicted embodiment, two cameras 27640 arepositioned in opposing corners of the procedure room; however, thecameras 27640 can be positioned and/or oriented in any suitable locationthat allows the cameras 27640 to cooperatively capture the procedureroom in an unimpeded manner. An artificial intelligence protocol detectsand/or identifies various devices, equipment and/or personnel and theircorresponding locations and/or orientations within the procedure room.

The cameras 27640 of the camera system are in communication with thesurgical hub 27650. Stated another way, the live feeds of the cameras27640 can be transmitted to the surgical hub 27650 for processing andanalysis. Through analysis of the footage collected by the cameras27640, the surgical hub 27650 is able to maintain a real-time inventoryof the devices, equipment, and/or personnel within the procedure roomand/or monitor and/or control the interactions between the detecteddevices, equipment and/or personnel. Using the images and/or datacollected by the camera system, the surgical hub 27650 is configured tobe informed regarding the identities of the detected devices, alert aclinician regarding compatibility concerns about the detected devices,and/or control various components of the surgical system 27600 based onthe presence and/or operation of the detected devices. The surgical hub27650 is configured to compare any detected devices to determinecompatibility between the devices and/or during the particular surgicalprocedure, facilitate the cooperation of two devices that are intendedto work together, and/or facilitate the cooperation of two devices thatbuild off of one another's sensed and/or controlled operations.

As shown in FIG. 15, an anesthesia cart 27670 and a preparation table27620 are positioned within a procedure room. The preparation table27620 is configured to support various surgical tools and/or devices ina manner that makes them easily accessible for use during a surgicalprocedure. Such surgical tools and/or devices can include replaceablestaple cartridges of varying sizes or shaft assemblies comprising endeffectors of varying sizes and/or functionalities, for example. In thedepicted embodiment, the preparation table 27620 supports a first device27630 a, a second device 27630 b, and a third device 27630 c.

The cameras 27640 are configured to detect identifying informationregarding the devices, equipment, and/or personnel located within theprocedure room. For example, the cameras 27640 can capture a serialnumber printed on a visible portion of each device 27630 a, 27630 b,27630 c, such as on a packaging of the devices, for example. In variousinstances, the packaging comprises a QR code printed thereon whichcontains information regarding a device contained therein. The QR codeis captured by the cameras 27640 and communicated to the surgical hub27650 for analysis and identification of the staple cartridge.

Such an identification system can be useful, for example, during asurgical procedure in which a surgical stapling instrument comprising anend effector, wherein a 60 mm staple cartridge is configured to beseated within the end effector. The cameras 27640 within the procedureroom are configured to capture the presence of a surgical staplinginstrument in the form of a live video feed and/or a still image, forexample. The cameras 27640 then communicate the captured image(s) to thesurgical hub 27650. The surgical hub 27650 is configured to identify thesurgical stapling instrument based on the image(s) received from thecameras 27640. In instances where the surgical hub 27650 is aware of thesurgical procedure to be performed, the surgical hub 27650 can alert theclinician as to whether or not the identified surgical staplinginstrument is appropriate. For example, knowing that a 45 mm staplecartridge is associated with a particular surgical procedure, thesurgical hub 27650 can alert the clinician that the detected surgicalstapling instrument is inappropriate, as the end effector of thedetected surgical stapling instrument is configured to receive a 60 mmstaple cartridge.

The surgical hub 27650 comprises a memory 27655 that stores thetechnical requirements and/or specifications associated with variousdevices therein. For example, the memory 27655 of the surgical hub 27650recognizes that the surgical stapling instrument described above isconfigured to receive a 60 mm staple cartridge. In various instances,the memory 27655 can also recognize a particular brand of 60 mm staplecartridges compatible with the surgical stapling instrument. In variousinstances, the cameras 27640 can capture the presence of replaceablestaple cartridges in the form of a live video feed and/or a still image,for example. The cameras 27640 then communicate the captured image(s) tothe surgical hub 27650. The surgical hub 27650 is configured to identifya characteristic of the replaceable staple cartridge based on theimage(s) received from the cameras 27640. Such characteristics include,for example, a size, a brand, and/or a manufacturing lot. As discussedin greater detail herein, the alert can be specific or generic. Ininstances where the cameras 27640 capture the presence of packagingcontaining a replaceable 45 mm staple cartridge, the surgical hub 27650is configured to alert the clinician that an incompatible staplecartridge has been mistakenly stocked within the room. Such an alert canprevent surgical instrument malfunction, injury to the patient, and/orvaluable time loss during the surgical procedure, for example.

As discussed above, the camera system is configured to facilitate thesurgical hub 27650 in coordinating the devices detected within theprocedure room. In various instances, a combination energy device and asmoke evacuation system are detected by the camera system. Thecombination energy device is configured to apply bipolar energy andmonopolar energy to patient tissue. As the camera system and/or thesurgical hub 27650 detects an activation of the combination energydevice, the presence of the combination energy device at a position nearthe patient, and/or the presence of smoke in the procedure room, thesurgical hub 27650 is configured to direct a generator to enable thesmoke evacuation system, for example.

A surgical instrument can utilize a measurable, or otherwise detectable,characteristic of an end effector to confirm a particular stage of thesurgical procedure and/or to control various operational parameters ofthe surgical instrument. Such a characteristic can include, for example,a distance between the jaws of the end effector. A memory of thesurgical instrument and/or the surgical hub comprises stored informationthat associates a particular jaw gap distance with a particular stage ofa surgical procedure. For example, when the distance between the jaws ismeasured between 0.030 inches and 0.500 inches, the surgical instrumentand/or the surgical hub confirms that the end effector is deliveringbipolar energy to patient tissue. In other instances, when the distancebetween the jaws is measured between 0.030 inches and 0.500 inches, thesurgical instrument and/or the surgical hub activates a generator,thereby initiating the delivery of bipolar energy to the patient tissue.Stated another way, a detection of a characteristic of the surgicalinstrument and/or contacted patient tissue can be used by the surgicalinstrument and/or the surgical hub in order to confirm and/or adapt theoperation of the surgical instrument.

FIG. 16 comprises a chart depicting various operational parametersand/or specifications of a surgical instrument that correspond tovarious stages of a surgical procedure. Similar to the surgicalinstruments described in greater detail herein, the surgical instrument27000 depicted in FIGS. 17-19 comprises a combination electrosurgicalfunctionality, wherein the surgical instrument includes an end effectorcomprising a first jaw 27810 and a second jaw 27820. At least one of thefirst jaw 27810 and the second jaw 27820 are movable with respect to oneanother, and the end effector is configurable between an openconfiguration and a closed configuration. The first jaw 27810 comprisesa first tissue-supporting and/or tissue-contacting surface 27815, andthe second jaw 27820 comprises a second tissue-supporting and/ortissue-contacting surface 27825. The first jaw 27810 and the second jaw27810 comprise electrodes disposed thereon. The electrosurgicalinstrument 27000 comprises one or more power generators configured tosupply power to the electrodes to energize the electrodes. Morespecifically, energy delivery to patient tissue supported between thefirst jaw and the second jaw is achieved by the electrodes which areconfigured to deliver energy in a monopolar mode, bipolar mode, and/or acombination mode. Alternating or blended bipolar and monopolar energiesare configured to be delivered in the combination mode. In at least oneembodiment, the at least one power generator comprises a battery, arechargeable battery, a disposable battery, and/or combinations thereof.

The end effector 27800 is used to perform various end effector functionsduring the surgical procedure. At an original time t₀, the end effector27800 is not in contact with the patient tissue T₁₀. Thus, theelectrodes of the end effector 27800 are not delivering any energy. Atthe original time t₀, the patient tissue T₁₀ is in a relaxed,uncompressed state. The end effector 27800 is shown in the openconfiguration. In the open configuration, a distance do spans anywherefrom 0.500 inches to 0.700 inches between the first tissue-supportingsurface 27815 and the second tissue-supporting surface 27825. Statedanother way, the tissue-supporting surfaces 27815, 27825 are separated amaximum distance do of 0.500 inches to 0.700 inches from one anotherwhen the end effector 27800 is in the open configuration.

At a first time t₁, the jaws 27810, 27820 of the end effector 27800 arebrought into contact with the patient tissue T_(t1). At least a portionof the patient tissue T_(t1) is positioned in between the jaws 27810,27820 of the end effector 27800 as the end effector 27800 moves from theopen configuration toward the closed configuration. As the jaws 27810,27820 are moved toward the closed configuration, the tissue T_(t1) iscompressed therebetween. At time t₁, the end effector 27800 isconfigured to deliver bipolar energy to the patient tissue T_(t1). Theapplication of bipolar energy allows the end effector 27800 to featherthrough parenchymal cells, for example. The end effector 27800 is in apartially closed configuration at time T₁. A first distance d₁ spansanywhere from 0.030 inches to 0.500 inches between the firsttissue-supporting surface 27815 and the second tissue-supporting surface27825 at time t₁. Stated another way, the tissue-supporting surfaces27815, 27825 are separated a maximum first distance d₁ of 0.030 inchesto 0.500 inches when the end effector is delivering bipolar energy tothe patient tissue T_(t1) at time t₁. A detailed depiction of the jaws27810, 27820 of the end effector 27800 delivering bipolar energy to thepatient tissue T_(t1) at a first time t₁ is shown in FIG. 17.

At a second time t₂, the jaws 27810, 27820 of the end effector 27800maintain contact with the patient tissue T_(t2). At least a portion ofthe patient tissue T_(t2) is positioned in between the jaws 27810, 27820of the end effector 27800. At time t₂, the end effector 27800 isconfigured to deliver a combination of bipolar and monopolar energies tothe patient tissue T_(t2). The application of bipolar energy andmonopolar energy allows the end effector 27800 to warm the patienttissue T_(t2). The end effector 27800 is in a partially closedconfiguration at time t₂; however, the end effector 27800 is closer to afully-closed configuration at time t₂ than the end effector 27800 attime t₁. More specifically, a second distance d₂ spans anywhere from0.010 inches to 0.030 inches between the first tissue-supporting surface27815 and the second tissue-supporting surface 27825 at time t₂. Statedanother way, the tissue-supporting surfaces 27815, 27825 are separated amaximum second distance d₂ of 0.010 inches to 0.030 inches when the endeffector is delivering bipolar and monopolar energies to the patienttissue T_(t2) at time t₂. A detailed depiction of the jaws 27810, 27820of the end effector 27800 delivering bipolar and monopolar energies tothe patient tissue T_(t2) at a second time t₂ is shown in FIG. 18.

At a third time t₃, the jaws 27810, 27820 of the end effector 27800maintain contact with the patient tissue T_(t3). At least a portion ofthe patient tissue T_(t3) is positioned in between the jaws 27810, 27820of the end effector 27800. At time t₃, the end effector 27800 isconfigured to continue delivering a combination of bipolar and monopolarenergies to the patient tissue T_(t3). The continued application ofbipolar energy and monopolar energy allows the end effector 27800 toseal the patient tissue T_(t3). The end effector 27800 is in a partiallyclosed and/or fully-closed configuration at time t₃. Stated another way,the end effector 27800 is in the fully-closed configuration and/orcloser to the fully-closed configuration at time t₃ than the endeffector 27800 at time t₂. More specifically, a third distance d₃ spansanywhere from 0.003 inches to 0.010 inches between the firsttissue-supporting surface 27815 and the second tissue-supporting surface27825 at time t₃. Stated another way, the tissue-supporting surfaces27815, 27825 are separated a maximum third distance d₃ of 0.003 inchesto 0.100 inches when the end effector is delivering bipolar andmonopolar energies to the patient tissue T_(t3) at time t₃. A detaileddepiction of the jaws 27810, 27820 of the end effector 27800 deliveringbipolar and monopolar energies to the patient tissue at a third time t₃is also shown in FIG. 18.

At a fourth time t₄, the jaws 27810, 27820 of the end effector 27800maintain contact with the patient tissue T_(t4). At least a portion ofthe patient tissue T_(t4) is positioned in between the jaws 27810, 27820of the end effector 27800 as the end effector 27800. At time t₄, the endeffector 27800 is configured to deliver monopolar energy to the patienttissue T_(t4). The application of monopolar energy allows the endeffector 27800 to cut through the patient tissue T_(t4). The endeffector 27800 is in a partially closed and/or fully-closedconfiguration at time t₄. Stated another way, the end effector 27800 isin the fully-closed configuration and/or closer to the fully-closedconfiguration at time t₄ than the end effector 27800 at time t₂. Morespecifically, a fourth distance d₄ spans anywhere from 0.003 inches to0.010 inches between the first tissue-supporting surface 27815 and thesecond tissue-supporting surface 27825 at time t₄. Stated another way,the tissue-supporting surfaces 27815, 27825 are separated a maximumfourth distance d₄ of 0.003 inches to 0.010 inches when the end effectoris delivering monopolar energy to the patient tissue T_(t4) at time t₄.A detailed depiction of the jaws 27810, 27820 of the end effector 27800delivering monopolar energy to the patient tissue T_(t4) at a fourthtime t₄ is shown in FIG. 19.

The graph 27900 shown in FIG. 20 illustrates the relationships betweenvarious operational parameters and/or specifications of the surgicalinstrument of FIGS. 16-19 with respect to time. The surgical instrumentand/or the surgical hub can utilize the depicted relationships toconfirm proper functionality of the surgical instrument during thesurgical procedure and/or to operate and/or adjust variousfunctionalities of the surgical instrument in response to one or moremeasured parameters. The graph illustrates (1) the change 27930 in thepower (W 27920 a of a generator controlling a bipolar modality of thesurgical instrument time 27910; (2) the change 27935 in the power (W27920 a of a generator controlling a monopolar modality of the surgicalinstrument over time 27910; (3) the change 27940 in the distance betweenthe jaws of the end effector 27920 b over time 27910; (4) the change27950 in the force of the jaw motor (F) 27920 c over time 27910; and (5)the change 27960 in the velocity of the jaw motor (V) 27920 d over time27910.

At time t₀, the electrodes of the end effector are not delivering energyto patient tissue, and the end effector is not yet in contact withpatient tissue. The distance 27920 b between the jaws of the endeffector is at a maximum at time to due to the end effector being in theopen configuration. The force to clamp 27950 the jaws is minimal fromtime t₀ to time t₁ as the end effector experiences little to noresistance from patient tissue when moving from the open configurationtoward the closed configuration. The jaws of the end effector continueto close around patient tissue from time t₁ to time t₂, over which timeperiod the end effector begins to deliver bipolar energy 27930. Thedistance between the jaws of the end effector is less at time t₁ than attime t₀. From time t₁ to time t₂, the jaw motor velocity 27960 begins toslow down as the force to clamp 27950 the jaws of the end effectorbegins to increase.

As described with respect to FIGS. 16-29, a combination of monopolarenergy 27935 and bipolar energy 27930 is delivered to patient tissuefrom time t₂ to time t₃. The jaws of the end effector continue to closearound patient tissue during this time period. The distance between thejaws of the end effector is less at time t₂ than at time t₁. Theparticular distance between the jaws of the end effector at time t₂indicates to the surgical instrument and/or the surgical hub that atissue-warming phase of the surgical procedure has been reached and thata combination of monopolar and bipolar energies should be and/or isbeing delivered to the patient tissue. From time t₂ to time t₃, the jawmotor velocity continues to decrease and is less than the jaw motorvelocity at t₁. The force required to clamp the jaws suddenly increasesbetween time t₂ and time t₃, thereby confirming to the surgicalinstrument and/or the surgical hub that a combination of monopolar andbipolar energies is being delivered to the patient tissue.

Monopolar and bipolar energies continue to be delivered to the patienttissue, and the patient tissue is sealed from time t₃ to time t₄. As theend effector reaches its fully-closed configuration at time t₃, theforce to clamp the jaws also reaches a maximum; however, the force toclamp the jaws remains stable between time t₃ and time t₄. The powerlevel of the generator delivering monopolar energy increases betweentime t₃ and time t₄, while the power level of the generator deliveringbipolar energy decreases between time t₃ and time t₄. Ultimately betweentime t₄ and to, monopolar energy is the only energy being delivered inorder to cut the patient tissue. While the patient tissue is being cut,the force to clamp the jaws of the end effector may vary. In instanceswhere the force to clamp the jaws decreases 27952 from its steady-statelevel maintained between time t₃ and t₄, an efficient and/or effectivetissue cut is recognized by the surgical instrument and/or the surgicalhub. In instances where the force to clamp the jaws increases 27954 fromits steady-state level maintained between time t₃ and t₄, an inefficientand/or ineffective tissue cut is recognized by the surgical instrumentand/or the surgical hub. In such instances, an error can be communicatedto the user.

In various instances, the clamping operation of the jaws of the endeffector can be adjusted based on a detected characteristic of contactedpatient tissue. In various instances, the detected characteristiccomprises tissue thickness and/or tissue type. For example, operationssuch as a range of gap distances between the jaws during a jaw closurestroke, a load threshold value, a rate of jaw closure, current limitsapplied during the jaw closure stroke, and/or a wait time between thejaw closure stroke and delivery of energy can be adjusted based on thedetected thickness of patient tissue. In various instances, the detectedcharacteristic of the contacted patient tissue can be used to adjusttissue weld parameters. More specifically, the detected characteristiccan be used to adjust a multi-frequency sweep of impedance sensing, abalance and/or sequence of energy modality, an energy delivery level, animpedance shutoff level, and/or a wait time between energy leveladjustments, for example.

As discussed in greater detail above, a surgical instrument and/or asurgical hub can utilize measured tissue characteristics to controland/or adjust an operational parameter of the surgical instrument. Forexample, tissue impedance can be detected as patient tissue ispositioned between the jaws of an end effector. The detection of tissueimpedance alerts the surgical instrument and/or the surgical hub thatthe jaws of the end effector are in contact with and/or near patienttissue. Referring now to FIG. 21, a graph 28000 illustrates the tissueimpedance 28020 calculated overtime 28010. When the jaws of the endeffector are not in contact with patient tissue, the tissue impedance28030 a is infinite. As the jaws of the end effector are clamped aroundthe patient tissue positioned therebetween, the patient tissue comesinto contact with both jaws. In such instances, the tissue impedance28030 b is measureable. The ability to measure tissue impedanceindicates to the surgical instrument and/or the surgical hub thatpatient tissue is appropriately positioned between the jaws of the endeffector. The surgical instrument and/or the surgical hub can theninitiate an operation, such as applying bipolar and/or monopolarenergies to the patient tissue, for example.

In various instances, the surgical instrument and/or the surgical hubcan utilize the magnitude of the detected tissue impedance to determinea phase of the surgical procedure. For example, as shown in FIG. 21, thetissue impedance 28030 b is measured at a first level upon initialcontact between the jaws of the end effector and the patient tissue. Thesurgical instrument can then begin to deliver bipolar energy to thepatient tissue. Upon the detected tissue impedance 28030 b increasing toand/or above a first pre-determined level, the surgical instrumentbegins to deliver a combination of bipolar and monopolar energies to thepatient tissue to warm the patient tissue and/or to form a seal. As thedetected tissue impedance 28030 b continues to increase, the tissueimpedance 28030 b reaches and/or exceeds a second pre-determined level,at which point the surgical instrument ceases delivery of the bipolarenergy while continuing to deliver monopolar energy to cut the patienttissue. Ultimately, the tissue impedance reaches an infinite level asthe patient tissue is no longer positioned between the jaws of the endeffector upon completion of the cut. In such instances, the surgicalinstrument and/or the surgical hub can cease delivery of the monopolarenergy.

In various instances, strain can be a metric used to adjust operationalparameters of the surgical instrument such as the clamping mechanism,for example. However, contact between the jaws of an end effector andpatient tissue is desirable for an accurate estimation of compressivestrain. As discussed in greater detail in reference to FIG. 21, asurgical instrument and/or a surgical hub can determine that contactexists between the jaws of the end effector and patient tissue bydetected tissue impedance. FIG. 22 illustrates an end effector 28100comprising a first jaw 28110 and a second jaw 28120, wherein the endeffector is in an open configuration. A gap D₀ ^(A) is defined betweenthe first jaw 28110 and the second jaw 28120 in the open configuration.The jaws 28110, 28120 of the end effector 28100 are configured toreceive patient tissue therebetween. At an initial time t₀, patienttissue T_(A,0) is positioned in between the first jaw 28110 and thesecond jaw 28120. Notably, the patient tissue T_(A,0) is in contact withboth the first jaw 28110 and the second jaw 28120. Stated another way, athickness of the patient tissue T_(A,0) is greater than or equal to thegap D₀ ^(A). As at least one of the first jaw 28110 and the second jaw28120 move toward one another, the patient tissue compresses and the gapD₁ ^(A) defined between the first jaw 28110 and the second jaw 28120 isreduced. The patient tissue T_(A,1) is shown compressed between thefirst jaw 28110 and the second jaw 28120 at time t₁. The compressivestrain can be calculated using the equation shown in FIG. 22. Becausethe patient tissue T_(A,0) was in contact with the jaws 28110, 28120 ofthe end effector 28100 at time t₀, the applied strain is calculatedaccurately.

FIG. 23 illustrates the end effector 28100 of FIG. 22 in the openconfiguration. A gap D₀ ^(B) is defined between the first jaw 28110 andthe second jaw 28120 in the open configuration. The jaws 28110, 28120 ofthe end effector 28100 are configured to receive patient tissuetherebetween. At an initial time t₀, patient tissue T_(B, 0) ispositioned in between the first jaw 28110 and the second jaw 28120.However, unlike the patient tissue T_(A,0), the patient tissue T_(B, 0)is not in contact with both the first jaw 28110 and the second jaw28120. Stated another way, a thickness of the patient tissue T_(B,0) isless than or equal to the gap D₀ ^(B). As at least one of the first jaw28110 and the second jaw 28120 move toward one another, the gap D₁ ^(B)defined between the first jaw 28110 and the second jaw 28120 is reduced.The patient tissue T_(B,1) is shown compressed between and/or in contactwith the first jaw 28110 and the second jaw 28120 at time t₁. Thecompressive strain can be calculated using the equation shown in FIG.23; however, the calculated compressive strain will be overestimated asthe patient tissue T_(B, 0) was not in contact with the jaws 28110,28120 of the end effector 28100 at time t₀.

As described above, calculating compressive strain by utilizing the gapdefined between the first jaw and the second jaw of the end effectorwhen the end effector is in the open configuration only leads to anaccurate calculation when the patient tissue is in contact with bothjaws of the end effector at an initial time t₀. Therefore, using thestandard gap defined between the first jaw and the second jaw of the endeffector when the end effector is in the open configuration is notdesirable. Instead, the gap defined between the first jaw and the secondjaw of the end effector when patient tissue initially contacts both jawsshould be used when calculating compressive strain. An end effector isshown in the open configuration 28150 in FIG. 24. Notably, the patienttissue is not in contact with both end effector jaws 28110, 28120. Thus,no dimensions and/or specifications of the end effector in thisconfiguration 28150 should be used in calculating compressive strain. Asat least one of the first jaw 28110 and the second jaw 28120 continue tomove toward one another, a gap D₀ ^(C) is defined between the first jaw28110 and the second jaw 28120. At an initial time t₀, patient tissueT_(C,0) is positioned in between the first jaw 28110 and the second jaw28120. Notably, the patient tissue T_(C,0) is now in contact with boththe first jaw 28110 and the second jaw 28120. Stated another way, athickness of the patient tissue T_(C,0) is greater than or equal to thegap D₀ ^(C). As at least one of the first jaw 28110 and the second jaw28120 continue to move toward one another, the patient tissue compressesand the gap D₁ ^(C) defined between the first jaw 28110 and the secondjaw 28120 is reduced. The patient tissue T_(C,1) is shown compressedbetween the first jaw 28110 and the second jaw 28120 at time t₁. Thecompressive strain can be calculated using the equation shown in FIG.24. As the patient tissue T_(C,0) was in contact with the jaws 28110,28120 of the end effector 28100 at time t₀ and the gap D₀ ^(C) definedbetween the first jaw 28110 and the second jaw 28120 at the point ofinitial tissue contact was realized, the applied strain is calculatedaccurately.

A motor control program of a combination electrosurgical instrument canutilize detected tissue stability as an input. The surgical instrumentcan detect compression rate and/or can measure the creep of the patienttissue compressed between end effector jaws to determine tissuestability. The control program can be modified to adjust wait timesbetween end effector functions, define when to make an additional tissuestability determination, and/or adjust the rate of jaw clamping based onthe determined tissue stability.

As shown in FIG. 25, an end effector 28250 comprises a first jaw 28254and a second jaw 28256, wherein at least one of the first jaw 28254 andthe second jaw 28256 is configured to move toward one another, whereinpatient tissue T is configured to be positioned therebetween. FIG. 25provides a schematic representation of the various positions of thefirst jaw 28254 and the second jaw 28256 with respect to patient tissueT during a jaw clamping stroke. The gap 28220 a defined between the jawsof the end effector and the motor current 28220 b required to clamp thejaws of the end effector vary over time 28210 due, at least in part, totissue stability measurement. An initial slope S₀ corresponds to the jawgap 28230 change between when the jaws are fully open to the point atwhich an initial contact is made between the jaws and the patient tissueT. The resulting motor current 28240 remains low while no tissue contactis present up until the end effector jaws contact the patient tissue T.The surgical system is configured to monitor the current 28220 b overtime 28210 to identify when the current slop flattens—i.e., when thetissue stabilizes. When the current slope flattens, the surgical systemis configured to take the difference between the peak current at thetime at which the end effector made initial contact with the tissue andthe point at which the current flattens out. Stated another way, thejaws are able to continue clamping the tissue positioned therebetweenwhen a wait time expires, wherein the wait time is defined by the timeit takes for the tissue compression to stabilize. The creep of the motorcurrent drives the next stage of motor current and velocity to thedesired jaw gap, or level of tissue compression. The measurement ofcreep is repeated to drive next stages of motor current and velocityuntil the final jaw cap, or level of tissue compression, is achieved.

In addition to sensing parameters associated with the jaw clampingstroke, the surgical system can monitor additional functions to adjustand/or refine operational parameters of the surgical instrument. Forexample, the surgical system can monitor an orientation of the surgicalinstrument with respect to the user and/or the patient, the impedance oftissue positioned between the jaws of the end effector to determinetissue position and/or tissue composition, the level of grounding to thepatient, and/or leakage current. Leakage current can be monitored todetermine secondary leakage from other devices and/or to createparasitic generated energy outputs through capacitive coupling.

In various instances, a surgical instrument is configured to modifyinstrument and/or generator settings and/or control programs using localunsupervised machine learning. In such instances, the surgicalinstrument may update and/or adjust local functional behaviors based ona summarization and/or aggregation of data from various surgicalprocedures performed with the same surgical instrument. Such functionalbehaviors can be adjusted based on previous uses and/or preferences of aparticular user and/or hospital. In such instances, a control program ofthe surgical instrument recognizes the same user and automaticallymodifies a default program with the preferences of the identified user.The surgical instrument is able to be updated by receiving regionaland/or global updates and/or improvements of digitally enabled controlprograms and/or displayed information through interaction with anon-local server.

In various instances, a surgical instrument is configured to modifyinstrument and/or generator settings and/or control programs usingglobal aggregation of instrument operational parameters and/or surgicalprocedure outcomes. A global surgical system is configured to collectdata regarding related and/or contributing instrument parameters suchas, for example, outcomes, complications, co-morbities, cost of surgicalinstrument, instrument utilization, procedure duration, procedure data,and/or patient data. The global surgical system is further configured tocollect data regarding generator operation data such as, for example,impedance curves, power levels, energy modalities, event annotation,and/or adverse incidents. The global surgical system is furtherconfigured to collect data regarding intelligent device operationparameters such as, for example, clamp time, tissue pressure, waittimes, number of uses, time of the patient on the operating table,battery levels, motor current, and/or actuation strokes. The globalsurgical system is configured to adapt default control programs and/orupdate existing control programs based on the detected operationalparameters. In this way, each surgical instrument within the globalsurgical system is able to perform the most effective and/or efficientsurgical procedures as possible.

FIG. 26 illustrates a network 28300 of surgical instruments 28310 thatcommunicate with a cloud-based storage medium 28320. The cloud-basedstorage medium 28320 is configured to receive data relating tooperational parameters from the surgical instrument 28310 that wascollected over numerous surgical procedures. The data is used by thecloud-based storage medium 28320 to optimize control programs to achieveefficient and/or desirable results. The cloud-based storage medium 28320is further configured to analyze all of the collected data in randombatches 28340. The results of the analysis from the random batches 28340can further be used in re-defining a control program. For example, thedata collected within Batch A might be representative of significantlydifferent wear profiles. A conclusion might then be able to be made fromthis data that suggests that instruments that adjust power rather thanclamp current degrade faster, for example. The cloud-based storagemedium 28320 is configured to communicate this finding and/or conclusionwith the surgical instrument. The surgical instrument could thenmaximize the life of the instrument by adjusting clamp current insteadof power and/or the surgical system could alert a clinician of thisfinding.

FIG. 26 illustrates a network 28300 of surgical instruments 28310 thatcommunicate with a cloud-based storage medium 28320. The cloud-basedstorage medium 28320 is configured to receive data relating tooperational parameters from the surgical instrument 28310 that wascollected over numerous surgical procedures. The data is used by thecloud-based storage medium 28320 to optimize control programs to achieveefficient and/or desirable results. The cloud-based storage medium 28320is further configured to analyze all of the collected data in randombatches 28340. The results of the analysis from the random batches 28340can further be used in re-defining a control program. For example, thedata collected within Batch A might be representative of significantlydifferent wear profiles. A conclusion might then be able to be made fromthis data that suggests that instruments that adjust power rather thanclamp current degrade faster, for example. The cloud-based storagemedium 28320 is configured to communicate this finding and/or conclusionwith the surgical instrument. The surgical instrument could thenmaximize the life of the instrument by adjusting clamp current insteadof power and/or the surgical system could alert a clinician of thisfinding.

The information gathered from the network 28300 of surgical instruments28310 by the cloud-based storage medium 28320 is presented in graphicalform in FIGS. 27 and 28. More specifically, a relationship between thegap 28430 defined between the jaws of the end effector from the point ofinitial tissue contact changes over time during a surgical procedure asa function of jaw motor clamp current 28440 is shown in FIG. 27. Thenumber of times that a particular end effector has reached afully-clamped state during the jaw clamping stroke impacts the amount offorce needed to clamp the same thickness tissue. For example, the jawsof the end effector are able to clamp to a greater degree with lesscurrent for instruments fully-clamped 1-10 times 28430 a thaninstruments fully-clamped 10-15 times 28430 b. Furthermore, the jaws ofthe end effector are able to clamp to a greater degree with less currentfor instruments fully-clamped 10-15 times 28430 b than instrumentsfully-clamped 16-20 times 28430 c. Ultimately, more force, and thereforecurrent, is needed to clamp the same thickness tissue to the samefully-clamped gap as the surgical instrument continues to be used. Acontrol program can be modified using the collected information from thesurgical instruments 28310 and the cloud-based storage medium 28320 toperform a more efficient and/or time-effective jaw clamping stroke.

The current required to clamp the same thickness tissue by achieving thesame fully-clamped gap between the jaws of the end effector is used toset a motor current threshold for a generator. As shown in FIG. 28, themotor current threshold is lower for an end effector that has reached afully-clamped state less than ten times, as less current is required toachieve the fully-clamped state. Thus, a control program sets a lowerthreshold generator power of newer end effectors than the thresholdgenerator power of older end effectors. If the same generator power wasused in an older end effector than what is used in a newer end effector,the tissue may not be sufficiently clamped and/or compressed between thejaws of the end effector. If the same generator power was used in anewer end effector that what is used in an older end effector, thetissue and/or the instrument may be damaged as the tissue may beover-compressed by the jaws of the end effector.

In various instances, a surgical system comprises modular components.For example, the surgical system comprises a surgical robot comprisingrobot arms, wherein the robot arms are configured to receive tools ofdifferent capabilities thereon. A control program of the surgical systemis modified based on the modular attachments, such as the type of toolsconnected to the surgical robot arms, for example. In other instances,the surgical system comprises a handheld surgical instrument configuredto receive different and/or replaceable end effectors thereon. Prior toperforming an intended surgical function, the handheld surgicalinstrument is configured to identify the attached end effector andmodify a control program based on the determined identity of the endeffector.

The surgical system is configured to identify the attached modularcomponent using adaptive and/or intelligent interrogation techniques. Invarious instances, the surgical system uses a combination of electricalinterrogations in combination with a mechanical actuation interrogationto determine the capacities and/or the capabilities of an attachedcomponent. Responses to interrogations can be recorded and/or comparedto information stored within a memory of the surgical system toestablish baseline operational parameters associated with the identifiedmodular attachment. In various instances, the established baselineparameters are stored within the memory of the surgical system to beused when the same or a similar modular attachment is identified in thefuture.

In various instances, an electrical interrogation signal is sent from ahandle of a surgical instrument to an attached modular component,wherein the electrical interrogation signal is sent in an effort todetermine an identity, an operational parameter, and/or a status of theattached modular component. The attached modular component is configuredto send a response signal with the identifying information. In variousinstances, no response is received to the interrogation signal and/orthe response signal comprises unidentifiable information. In suchinstances, a surgical instrument can perform a default function in orderto assess the capabilities of the attached modular component. Thedefault function is defined by conservative operational parameters.Stated another way, the default operational parameters used during aperformance of the default function are defined to a particular level soas to avoid damage to the surgical instrument and/or the attachedmodular component, injury to the patient, and/or injury to the user. Thesurgical instrument is configured to utilize results of the defaultfunction in order to set an operating program specific to the attachedmodular component.

For example, a surgical instrument can perform a tissue cutting stroke,wherein a cutting member traverses through an attached end effector froma proximal position toward a distal position. In instances where thesurgical instrument is unable to identify the attached end effector, thesurgical instrument is configured to perform the tissue cutting strokeusing the default operational parameters. Utilizing a position of thecutting member within the end effector at the end of the tissue cuttingstroke, the surgical instrument can determine a length of the tissuecutting stroke associated and/or appropriate for completion with theattached end effector. The surgical instrument is configured to recordthe distal-most position of the cutting member in order to setadditional operational parameters associated with the attached endeffector. Such additional operational parameters include, for example, aspeed of the cutting element during the tissue cutting stroke and/or thelength of the end effector.

The default function can also be used to determine a current stateand/or status of the attached modular component. For example, thedefault function can be performed to determine if the attached endeffector is articulated and/or to what degree the attached end effectoris articulated. The surgical instrument is then configured to adjust acontrol program accordingly. A length of the cutting stroke changes asthe end effector is articulated across a range of articulation angles.Stated another way, the length of the cutting stroke is different whenthe end effector is in articulated state as compared to when the endeffector is in an unarticulated state. The surgical instrument isconfigured to update a control program to perform cutting strokesspanning the length associated with the last detected full stroke. Thesurgical instrument is further configured to use the length of the lastcompleted cutting stroke to determine if the full length of the cuttingstroke is accomplished and/or completed with the current control programwhen the end effector is unarticulated compared to when the end effectoris articulated.

In various instances, the surgical system can perform an intelligentassessment of a characteristic of the attached component. Such acharacteristic includes, for example, tissue pad wear, degree ofattachment usage, and/or operating condition of the attachment. Statedanother way, the surgical system is configured to assess thefunctionality and/or condition of the attached component. Upon detectingthe characteristic of the attached modular component, a control programused to operate the surgical system is adjusted accordingly.

A surgical instrument comprises one or more tissue pads positioned onthe jaws of an end effector. It is generally well known that tissue padstend to degrade and wear over time due to frictional engagement with ablade when no tissue is present therebetween, for example. The surgicalinstrument is configured to determine a degree of tissue pad wear byanalyzing the remaining tissue pad thickness and/or stiffness, forexample. Utilizing the determined status of the tissue pad(s), thesurgical instrument adjusts a control program accordingly. For example,the control program can alter an applied pressure and/or a power levelof the surgical instrument based on the determined status of the tissuepad(s). In various instances, the power level of the surgical instrumentcan be automatically reduced by a processor of the surgical instrumentin response to a detected thickness of the tissue pad(s) that is lessthan a threshold thickness.

A surgical instrument comprises a combination electrosurgicalfunctionality, wherein the surgical instrument includes an end effectorcomprising a first jaw and a second jaw. At least one of the first jawand the second jaw is configured to move toward one another totransition the end effector between an open configuration and a closedconfiguration. The first jaw and the second jaw comprise electrodesdisposed thereon. The electrosurgical instrument comprises one or morepower generators configured to supply power to the electrodes toenergize the electrodes. The surgical instrument can assess a degree ofcharring and/or tissue contamination on one or more of the end effectorjaws by measuring an impedance when the end effector is in the closedconfiguration without any patient tissue positioned therebetween. Apre-determined impedance can be stored within a memory of the surgicalinstrument, wherein if the impedance exceeds the pre-determinedthreshold, the jaws comprise an undesirable level of char and/or tissuecontamination thereon. As discussed in greater detail herein, an alertcan be issued to a user upon detection of an undesirable level of char.In various instances, an operational parameter can automatically beadjusted by a processor of the surgical instrument and/or a surgical hubin response to the detected closed jaw impedance. Such operationalparameters include power level, applied pressure level, and/or advancedtissue cutting parameters, for example.

As shown in FIG. 29, a graphical representation 28500 illustrates arelationship 28530 between the measured impedance 28250 and a number ofactivation cycles 28510. A baseline impedance is measured and recordedwithin the memory prior to any energy activation (n=0 activations). Asdiscussed above, the impedance is measured when the end effector of thesurgical instrument is in the closed configuration and no patient tissueis positioned therebetween. The surgical instrument and/or a surgicalhub prompts a user to transition the end effector into the closedconfiguration for the closed jaw impedance to be measured. Such promptscan be delivered at pre-defined activation intervals, such as n=5, 10,15, etc., for example. As char and/or tissue contamination accumulate onthe jaws of the end effector, impedance increases. At and/or above afirst pre-determined level 28540, the surgical instrument and/or thesurgical hub is configured to alert the user of such char accumulationand advise the user to clean the end effector. At and/or above a secondpre-determined level 28550, the surgical instrument and/or the surgicalhub can prevent the user from using various operational functions of thesurgical instrument until the end effector is cleaned. The operationallockout can be removed upon cleaning of the end effector, assuming thatthe measured impedance has reduced to an acceptable level.

As discussed above, the surgical hub and/or the surgical instrument isconfigured to alert a user when a pre-determined impedance is met and/orexceeded. Such an alert can be communicated through various forms offeedback, including, for example, haptic, acoustic, and/or visualfeedback. In at least one instance, the feedback comprises audiofeedback, and the surgical instrument can comprise a speaker which emitsa sound, such as a beep, for example, when an error is detected. Incertain instances, the feedback comprises visual feedback and thesurgical instrument can comprise a light emitting diode (LED), forexample, which flashes when an error is detected. In certain instances,the visual feedback can be communicated to a user through an alertpresented on a display monitor within a field of vision of the user. Invarious instances, the feedback comprises haptic feedback, and thesurgical instrument can comprise an electric motor comprising aneccentric element which vibrates when an error is detected. The alertcan be specific or generic. For example, the alert can specificallystate that the closed jaw impedance exceeded a pre-determined level, orthe alert can specifically state the measured impedance.

In various instances, the surgical instrument and/or the surgical hub isconfigured to detect parameters such as integral shaft stretch, damage,and/or tolerance stack up to compensate for functional parameteroperations of motorized actuators. The surgical instrument is configuredto alert a user when a detected parameter of the attached end effectorand/or shaft is close to being and/or is outside of desirable operatingranges specific to the attached component. In addition to alerting theuser, in various instances, operation of the surgical instrument isprevented when it has been detected that the surgical instrument isincapable of operating within a pre-defined envelope of adjustment. Thesurgical instrument and/or the surgical hub comprises an override,wherein the user is allowed to override the lockout in certainpre-defined conditions. Such pre-defined conditions include anemergency, the surgical instrument is currently in use during a surgicalprocedure where the inability to use the surgical instrument wouldresult in harm to the patient, and a single use override to allow forone additional use of the surgical instrument at the discretion of theuser. In various instances, an override is also available to allow auser to perform a secondary end effector function that is unrelated to aprimary end effector function. For example, if a surgical instrumentprevents the jaws of the end effector from being articulated, the usermay activate the override to allow the surgical instrument to articulatethe end effector.

A surgical system can adapt a control program configured to operate asurgical instrument in response to a detected instrument actuationparameter, an energy generator parameter, and/or a user input. Adetermined status of the surgical instrument is used in combination withthe user input to adapt the control program. The determined status ofthe surgical instrument can include whether an end effector is in itsopen configuration, whether an end effector is in its closedconfiguration and/or whether a tissue impedance is detectable, forexample. The determined status of the surgical instrument can includemore than one detected characteristic. For example, the determinedstatus of the surgical instrument can be assessed using a combination oftwo or more measures, a series of ordered operations, and/orinterpretations of a familiar user input based on its situational usage.The control program is configured to adjust various functions of thesurgical instrument such as the power level, an incremental step up orstep down of power, and/or various motor control parameters, forexample.

A surgical system comprises a surgical instrument including acombination electrosurgical functionality, wherein the surgicalinstrument includes an end effector comprising a first jaw and a secondjaw with electrodes disposed thereon. The electrosurgical instrumentcomprises one or more power generators configured to supply power to theelectrodes to energize the electrodes. More specifically, energydelivery to patient tissue supported between the first jaw and thesecond jaw is achieved by the electrodes which are configured to deliverenergy in a monopolar mode, bipolar mode, and/or a combination mode withalternating or blended bipolar and monopolar energies. As described ingreater detail herein, the surgical system can adapt a level of energypower activation of the one or more generators based on variousmonitored parameters of the surgical instrument.

The surgical system is configured to adapt energy power activation basedon instrument monitored parameters. In various instances, the surgicalsystem can monitor the sequence in which various surgical instrumentfunctions are activated. The surgical system can then automaticallyadjust various operating parameters based on the activation of surgicalinstrument functions. For example, the surgical system can monitor theactivation of rotation and/or articulation controls and prevent theability for the surgical instrument to deliver energy to patient tissuewhile such secondary non-clamp controls are in use.

In various instances, the surgical system can adapt instrument powerlevels to compensate for detected operating parameters such asinadequate battery and/or motor drive power levels, for example. Thedetection of inadequate battery and/or motor drive power levels canindicate to the surgical system that clamp strength of the end effectoris impacted and/or impaired, thereby resulting in undesirable controlover the patient tissue positioned therebetween, for example.

The surgical system can record operating parameters of the surgicalinstrument during periods of use that are associated with a particularintended function. The surgical system can then use the recordedoperating parameters to adapt energy power levels and/or surgicalinstrument modes, for example, when the surgical system identifies thatthe particular intended function is being performed. Stated another way,the surgical system can automatically adjust energy power levels and/orsurgical instrument modes with stored preferred operating parameterswhen a desired function of the surgical instrument is identified and/orthe surgical instrument can adjust energy power levels and/or surgicalinstrument modes in an effort to support and compliment the desiredfunction. For example, a surgical system can supplement a detectedlateral loading on the shaft with application of monopolar power, asdetected lateral loading on the shaft often results from abrasivedissection with the end effector in its closed configuration. Thesurgical system decided to apply monopolar power, as the surgical systemis aware, through previous procedures and/or through information storedin the memory, that monopolar power results in improved dissection. Invarious instances, the surgical system is configured to apply themonopolar power proportionate to increases in the detected lateral load.

The surgical system can adapt a control program configured to operate asurgical instrument in response to a detected end effector parameter. Asshown in FIG. 30, a surgical instrument can utilize measured tissueconductance to automatically modify a gap clamp control program. Tissueconductance is measured at two frequencies such as 50 kHz and 5 MHz, forexample. Low frequency conductance (GE) is driven by extracellularfluid, whereas high frequency conductance (GI) is driven byintracellular fluid. The intracellular fluid levels change through ascells become damaged, for example. The end effector is configurable inan open configuration and a closed configuration. Thus, as the endeffector is motivated from its open configuration toward its closedconfiguration, the jaws of the end effector compress the tissuepositioned therebetween. During the tissue compression, changes in theconductance between the two frequencies can be detected and/or recorded.The surgical system is configured to adapt the control program tocontrol end effector clamp compression based on the ratio of lowfrequency conductance (GE) to high frequency conductance (GI). Thesurgical system adapts the control program until a discretepre-determined point and/or until an inflection point is approached,whereby the pre-determined point and/or the inflection point indicatethat cellular damage could be near.

More specifically, FIG. 30 is a graphical representation 29000 ofrelationships between measured tissue conductance 29100, a ratio of lowfrequency conductance to high frequency conductance 29200, dimension ofjaw aperture 29300, and jaw motor force 29400 over the duration 29010 ofa jaw clamp stroke. At the beginning of the jaw clamp stroke, measuredtissue conductance is at its lowest as the jaws of the end effectorinitially come into contact with patient tissue, and the jaw aperture29300 is at its largest value when the end effector is in its openconfiguration. Due, at least in part, to the small amount of resistanceprovided against the jaws from the tissue positioned therebetween, thejaw motor force is low at the beginning of the jaw clamp stroke. Priorto compression, but after contact between the patient tissue and thejaws of the end effector, the low frequency conductance 29110 increasesindicating the presence of extracellular fluid within the capturedtissue. Similarly, prior to compression, but after contact between thepatient tissue and the jaws of the end effector, the high energyconductance 29120 increases indicating the presence of intracellularfluid.

As the end effector begins to move toward its closed configuration, thejaws of the end effector begin to clamp the tissue positionedtherebetween, and thus, the jaw aperture 29300 continues to decrease.The tissue begins to be compressed by the jaws; however until fluidbegins to expel from the compressed tissue, the patient tissue is notdesirable to be sealed by the surgical instrument. The jaw motor forcecontinues to increase during the jaw clamp stroke, as increasedresistance is expelled against the end effector jaws by the capturedtissue.

After the initial expulsion of extracellular fluid causes a decrease inthe low frequency conductance (GE) 29110, the low frequency conductance(GE) 29110 remains relatively constant during the jaw clamp stroke. Thehigh frequency conductance (GI) 29120 remains relatively constant duringthe jaw clamp stroke until after the patient tissue is sealed. As thetissue continues to be compressed after the seal is completed,intracellular tissue damage occurs and the intracellular fluid isexpelled. At such point, the high frequency conductance 29120 decreases,causing a spike in the ratio 29210 of low frequency conductance to highfrequency conductance. A tissue damage threshold 29220 is predeterminedto alert a user and/or automatically prompt the surgical system tomodify operational parameters when the spike in the ratio 29210 of lowfrequency conductance to high frequency conductance reaches and/orexceeds the tissue damage threshold 29220. At such point, the surgicalsystem is configured to modify the control program to stop motivatingthe jaws of the end effector toward the closed configuration of the endeffector and/or begin motivating the jaws of the end effector backtoward the open configuration of the end effector. In various instances,the surgical system is configured to modify the control program toreduce the jaw clamp force. Such adaptation of the control programprevents additional tissue damage.

A surgical system is configured to modify a control program based oncooperative dual inputs. More specifically, a surgical system can vary amotor actuation rate based on a user input and pre-defined settings. Forexample, the more force that a user applies to a handle control, thefaster the motor is actuated to trigger the system. In variousinstances, a handle control can be used to communicate differentcommands to the surgical system depending on its situational usage. Morespecifically, the surgical system can monitor and/or record a particularuser input. The particular user input can be analyzed for its length,duration, and/or any suitable characteristic that can be used todistinguish the input. For example, a handle of a surgical instrumentcan include a trigger, wherein the trigger is configured to controlshaft rotation. In various instances, faster actuation of the triggercorresponds to an increase in the rate at which the shaft is rotated;however, the maximum force (current) threshold of the motor remainsconstant. In other instances, faster actuation of the triggerscorresponds to an increase in force being applied while a rotation speedthreshold remains the same. Such control can be further differentiatedby the shaft rotation speed being increased based on the duration that auser actuates the trigger while the force is based on the rate at whichthe trigger is actuated.

In various instances, motor actuation control is based on a combinationof a pre-defined setting and a detection of an instrument operatingparameter and/or a user control parameter. FIG. 31 is a graphicalrepresentation 29500 of the relationship between actual jaw closurespeed 29520 and a trigger speed indicated by a user input 29510. The jawclosure speed 29520 resulting solely from a corresponding user input29510 is represented by a first line 29530. As the user input triggerspeed 29510 increases, the jaw closure speed 29520 also increases. Sucha relationship 29530 is determined without the consideration of anyadditional parameters. The jaw closure speed 29520 resulting from acorresponding user input 29510 and a determination of thick tissuepositioned between the jaws of the end effector is represented by asecond line 29540. As the user input trigger speed 29510 increases, thejaw closure speed 29520 also increases; however, the jaw closure speed29520 is less than if the user input trigger speed was being consideredalone. The additional consideration of tissue thickness slows the jawclosure speed down in order to prevent damage to the patient tissueand/or the surgical instrument, for example.

A surgical system comprises numerous components. For example, thesurgical system comprises numerous handheld surgical instruments, asurgical hub, and a surgical robot. In various instances, each componentof the surgical system is in communication with the other components andcan issue commands and/or alter a control program based on at least onemonitored parameter and/or a user input. The surgical system comprisesmeans to determine which system is in charge and which system makesportions of operational decisions. This designation can be changed basedon situational awareness, the occurrence of pre-determined events,and/or the exceedance of thresholds. In various instances, a commandprotocol can be established within the surgical system to indicate atype of command each component is able to issue and/or to whichcomponents within the surgical system the issuing component can direct acommand.

The command protocol can use pre-defined thresholds to determine when acontrol hand-off is warranted. For example, the surgical systemcomprises a generator and a handheld surgical instrument includingvarious controls therein. At the beginning of a surgical procedure, thegenerator is initially in control and adjusts the power based ondetected impedance. The generator uses the detected impedance and/or thecurrent power level to command a pressure control within a handle of thesurgical instrument to follow specific pressure needs. At a point duringthe surgical procedure, a lower impedance threshold is exceededindicative that the generator algorithm has detected an electricalshort. The generator passes control to the pressure control within thehandle by instructing the pressure control to determine if tissue isstill positioned between the jaws of the end effector. The pressurecontrol is then able to determine an appropriate tissue compression andcan communicate what power level and/or energy modality is mostappropriate for the detected tissue.

The control protocol can be determined based on a consensus reached by aplurality of the components within the surgical system. For example,three components within the surgical system detect a first valuerelating to a monitored parameter while two components within thesurgical system detect a second value relating to the same monitoredparameter, wherein the first value and the second value are different.The group of three components comprise more components than the group oftwo components, and thus, the first value of the monitored parametercontrols. Each component within the surgical system can be assigned apositioned within a hierarchy. The hierarchy can be established based onreliability of the particular component and/or the capabilities of theparticular component. A first component detects a first value relatingto a monitored parameter, and a second component detects a second valuerelating to the same monitored parameter, wherein the first value isdifferent than the second value. The second component “outranks” thefirst component within the hierarchy of the surgical system, and thus,the second value of the monitored parameter detected by the secondcomponent controls.

Various aspects of the subject matter described herein are set out inthe following examples.

Example Set 1

Example 1—A surgical system comprising a surgical instrument, agenerator configured to supply power to an end effector, and a processorconfigured to run a control program to operate the surgical system. Thesurgical instrument comprises the end effector that includes a first jawand a second jaw. At least one of the first jaw and the second jaw ismoved with respect to one another between an open position and a closedposition. Tissue is configured to be positioned between the first jawand the second jaw. The processor is configured to detect a firstparameter of the surgical system, detect at least one user input, andmodify the control program in response to the detected first parameterand the at least one user input.

Example 2—The surgical system of Example 1, wherein the control programis configured to control a power level of the generator.

Example 3—The surgical system of Examples 1 or 2, wherein the controlprogram is configured to control a motor, wherein the motor isconfigured to cause the end effector to move between the openconfiguration and the closed configuration.

Example 4—The surgical system of Example 3, wherein the control programis configured to control the motor through motor control parameters, andwherein the control program is configured to adjust the motor controlparameters in response to the detected first parameter and the detecteduser input.

Example 5—The surgical system of Examples 1, 2, 3, or 4, wherein thefirst parameter comprises an instrument actuation parameter.

Example 6—The surgical system of Examples 1, 2, 3, 4, or 5, wherein thefirst parameter comprises a generator operating parameter.

Example 7—The surgical system of Examples 1, 2, 3, 4, 5, or 6, whereinthe first parameter comprises a status of the end effector.

Example 8—The surgical system of Examples 1, 2, 3, 4, 5, 6, or 7,wherein the first parameter indicates whether the end effector is in theopen configuration or the closed configuration.

Example 9—The surgical system of Examples 1, 2, 3, 4, 5, 6, or 7,wherein the first parameter indicates whether the tissue is positionedbetween the first jaw and the second jaw.

Example 10—The surgical system of Examples 1, 2, 3, 4, 5, 6, 7, 8, or 9,wherein the surgical instrument is in operational control, and whereinthe generator is a slave control system by default.

Example 11—The surgical system of Examples 1, 2, 3, 4, 5, 6, 7, 8, or 9,wherein the control program is configured to cause the generator to bein operational control and the surgical instrument to be the slavecontrol system in response to the detected first parameter and thedetected user input.

Example 12—The surgical system of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9,10, or 11, wherein the first parameter comprises a combination of twomeasures.

Example 13—The surgical system of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9,10, 11, or 12, wherein the surgical system further comprises a triggerconfigured to receive the user input, wherein the processor isconfigured to interpret multiple user inputs received by the trigger,wherein each user input comprises a different meaning based onsituational usage.

Example 14—A surgical system comprising a surgical instrument, agenerator configured to supply power to the surgical instrument, and aprocessor configured to run a control program to operate the surgicalsystem. The processor is configured to detect a status of the surgicalinstrument, detect at least one user input, and adapt the controlprogram in response to the detected status of the surgical instrumentand the at least one user input.

Example 15—The surgical system of Example 14, wherein the surgicalinstrument comprises an end effector, wherein the end effector isconfigurable in an open configuration and a closed configuration, andwherein the status of the surgical instrument corresponds to whether theend effector is in the open configuration or the closed configuration.

Example 16—The surgical system of Examples 14 or 15, wherein thesurgical instrument comprises an end effector, wherein the end effectoris configurable in an open configuration and a closed configuration, andwherein the status of the surgical instrument corresponds to whetherpatient tissue is positioned between the first jaw and the second jaw.

Example 17—The surgical system of Examples 14, 15, or 16, wherein thesurgical system further comprises an input member configured to receivethe user input, wherein the processor is configured to interpretmultiple user inputs received by the input member, wherein each receiveduser input comprises a different meaning based on situational usage ofthe surgical system.

Example 18—A surgical system comprising a surgical instrument, agenerator configured to supply power to an end effector, and a processorconfigured to run a control program to operate the surgical system. Thesurgical instrument comprises the end effector which includes a firstjaw and a second jaw. At least one of the first jaw and the second jawis moved with respect to one another between an open position and aclosed position. Tissue is configured to be positioned between the firstjaw and the second jaw. The processor is configured to detect a firstparameter of the surgical instrument, detect a second parameter of thegenerator, detect at least one user input, and modify the controlprogram in response to the detected first parameter, the detected secondparameter, and the at least one user input.

Example 19—The surgical system of Example 18, wherein the firstparameter of the surgical instrument corresponds to whether the endeffector is in the open configuration or the closed configuration andwhether patient tissue is positioned between the first jaw and thesecond jaw.

Example 20—The surgical system of Examples 18 or 19, wherein thesurgical instrument further comprises an input member configured toreceive the user input, wherein the processor is configured to interpretmultiple user inputs received by the input member, wherein each receiveduser input comprises a different meaning based on situational usage ofthe surgical instrument within the surgical system.

Example Set 2

Example 1—A surgical instrument comprising a housing, a shaft assembly,a processor, and a memory. The shaft assembly is replaceably connectedto the housing. The shaft assembly comprises an end effector. The memoryis configured to store program instructions which, when executed fromthe memory cause the processor to send an electrical interrogationsignal to the attached shaft assembly, receive a response signal fromthe attached shaft assembly, cause a default function to be performedwhen a response signal is not received by the attached shaft assembly,determine an identifying characteristic of the attached shaft assemblyas a result of the performance of the default function, and modify acontrol program based on the identifying characteristic of the attachedshaft assembly.

Example 2—The surgical instrument of Example 1, wherein the identifyingcharacteristic comprises remaining capacity of the attached shaftassembly.

Example 3—The surgical instrument of Examples 1 or 2, wherein theidentifying characteristic comprises a performance level of the attachedshaft assembly.

Example 4—The surgical instrument of Examples 1, 2, or 3, wherein theidentifying characteristic is different for attached shaft assemblies ofdifferent capabilities.

Example 5—The surgical instrument of Example 1, 2, 3, or 4, wherein thememory comprises a lookup table comprising operating parameterscorresponding to particular shaft assemblies, wherein the processorutilizes the received response signal to identify the attached shaftassembly within the lookup table, and wherein the control program ismodified using the stored operating parameters corresponding to theidentified shaft assembly.

Example 6—The surgical instrument of Examples 1, 2, 3, 4, or 5, whereinthe memory further comprises program instructions which, when executed,cause the processor to store the modified control program in the memory.

Example 7—A surgical instrument comprising a housing, a shaft assembly,a processor, and a memory. The shaft assembly is replaceably connectedto the housing. The shaft assembly comprises an end effector. The memoryis configured to store program instructions which, when executed fromthe memory cause the processor to send a variable interrogativecommunication to the attached shaft assembly, determine a capability ofthe attached shaft assembly based on a response to the variableinterrogative communication, and modify a control program based on thedetermined capability of the attached shaft assembly.

Example 8—The surgical instrument of Example 7, wherein the variableinterrogative communication comprises an electrical interrogation signaland a physical actuation of the surgical instrument.

Example 9—The surgical instrument of Examples 7 or 8, wherein thephysical actuation of the surgical instrument is monitored to determinea functional capability of the attached shaft assembly.

Example 10—The surgical instrument of Examples 7, 8, or 9, wherein thedetermined capability relates to a remaining capacity of the shaftassembly.

Example 11—The surgical instrument of Examples 7, 8, 9, or 10, whereinthe determined capability relates to a performance level of the shaftassembly.

Example 12—The surgical instrument of Examples 7, 8, 9, 10, or 11,wherein the capability to be determined differs based on the connectedshaft assembly.

Example 13—The surgical instrument of Examples 7, 8, 9, 10, 11, or 12,wherein the memory further comprises further comprises programinstructions which, when executed, cause the processor to store themodified control program and the determined shaft assembly capability inthe memory.

Example 14—A surgical instrument comprising a housing, a shaft assembly,a processor, and a memory. The shaft assembly is interchangeably coupledto the housing. The shaft assembly comprises an end effector. The memoryis configured to store program instructions which, when executed fromthe memory, cause the processor to send an interrogation signal to theshaft assembly coupled to the housing, receive a response signal fromthe shaft assembly coupled to the housing, cause a default end effectorfunction to be performed when a response signal is not recognized,determine an identifying characteristic of the shaft assembly coupled tothe housing as a result of the performance of the default end effectorfunction, and modify a control program based on the identifyingcharacteristic of the shaft assembly coupled to the housing.

Example 15—The surgical instrument of Example 14, wherein the responsesignal is not recognized by the processor because the response signal isnot received by the processor.

Example 16—The surgical instrument of Examples 14 or 15, wherein theidentifying characteristic comprises remaining capacity of the shaftassembly coupled to the housing.

Example 17—The surgical instrument of Examples 14, 15, or 16, whereinthe identifying characteristic comprises a performance level of theshaft assembly coupled to the housing.

Example 18—The surgical instrument of Examples 14, 15, 16, or 17,wherein the determined characteristic can differ based on the shaftassembly interchangeably coupled to the housing.

Example 19—The surgical instrument of Examples 14, 15, 16, 17, or 18,wherein the memory comprises a lookup table comprising operatingparameters corresponding to particular shaft assemblies, wherein theprocessor utilizes the received response signal to identify the shaftassembly coupled to the housing within the lookup table, and wherein thecontrol program is modified using the stored operating parameterscorresponding to the identified shaft assembly.

Example 20—The surgical instrument of Examples 14, 15, 16, 17, 18, or19, wherein the memory further comprises program instructions which,when executed, cause the processor to store the modified control programin the memory.

Example Set 3

Example 1—A surgical system comprising a surgical hub, a surgicalinstrument, a generator configured to energize an end effector; and asmoke evacuation system configured to remove smoke from a surgical site.The surgical instrument comprises the end effector. A control command ispassed directly from the surgical hub to the surgical instrument. Thesurgical instrument is configured to pass the control command receivedfrom the surgical hub to the generator and the smoke evacuation systemin a daisy-chain manner.

Example 2—The surgical system of Example 1, wherein the surgicalinstrument is configured to modify the control command with a parameterdetected by the surgical instrument.

Example 3—The surgical system of Example 2, wherein the surgicalinstrument is configured to pass the modified control command to thegenerator.

Example 4—The surgical system of Examples 2 or 3, wherein an operatingparameter of the generator is controlled by the modified controlcommand.

Example 5—The surgical system of Examples 2, 3, or 4, wherein thegenerator is configured to alter the modified control command with asecond parameter detected by the generator.

Example 6—The surgical system of Examples 2, 3, 4, or 5, wherein thesurgical instrument is configured to pass the modified control commandto the surgical hub, and wherein the surgical hub is configured to passthe modified control command to the generator.

Example 7—The surgical system of Example 1, wherein the surgicalinstrument detects a first parameter of the surgical instrument, whereinthe surgical instrument is configured to communicate the detected firstparameter to the generator, and wherein generator is configured tomodify the control command with the first parameter.

Example 8—The surgical system of Example 1, wherein the surgicalinstrument detects a first parameter of the surgical instrument, whereinthe surgical instrument is configured to communicate the detected firstparameter to the generator, wherein the generator detects a secondparameter, and wherein the generator is configured to modify the controlcommand with the first parameter and the second parameter.

Example 9—The surgical system of Examples 1, 2, 3, 4, 5, 6, 7, or 8,further comprising a display screen configured to display a live feed ofa surgical site and a first operating parameter of the surgicalinstrument.

Example 10—The surgical system of Example 9, wherein the surgicalinstrument further comprises an instrument display configured to displaya second operating parameter of the surgical instrument, and wherein thefirst operating parameter is the same as the second operating parameter.

Example 11—The surgical system of Example 9, wherein the surgicalinstrument further comprises an instrument display configured to displaya second operating parameter of the surgical instrument, and wherein thefirst operating parameter is different than the second operatingparameter.

Example 12—The surgical system of Examples 9, 10, or 11, wherein thedisplay screen is further configured to display an operating parameterof the generator.

Example 13—A surgical system comprising a surgical hub, a surgicalinstrument, a generator configured to energize an end effector, and asmoke evacuation system configured to remove smoke from a surgical site.The surgical instrument comprises the end effector. A control command ispassed directly from the surgical hub to the surgical instrument. Thesurgical instrument is configured to pass the control command receivedfrom the surgical hub to the generator and the smoke evacuation system.

Example 14—The surgical system of Example 13, wherein the surgicalinstrument is configured to pass the control command received from thesurgical hub to the generator and the smoke evacuation system in adaisy-chain manner.

Example 15—A surgical system comprising a surgical hub, a first surgicalinstrument, a first generator configured to energize a first endeffector, and a second surgical instrument. The first surgicalinstrument comprises the first end effector. A control command is passeddirectly from the surgical hub to the first surgical instrument. Thefirst surgical instrument is configured to pass the control commandreceived from the surgical hub to the first generator and the secondsurgical instrument in a daisy-chain manner.

Example 16—The surgical system of Example 15, wherein the first surgicalinstrument is configured to modify the control command with a firstparameter detected by the first surgical instrument.

Example 17—The surgical system of Example 16, wherein the first surgicalinstrument is configured to pass the modified control command to thesecond surgical instrument.

Example 18—The surgical system of Example 17, wherein the secondsurgical instrument is configured to alter the modified control commandwith a second parameter detected by the second surgical instrument, andwherein the second surgical instrument is configured to pass the alteredcontrol command to the first surgical instrument.

Example 19—The surgical system of Example 15, wherein the first surgicalinstrument is configured to detect a first parameter, wherein the secondsurgical instrument is configured to detect a second parameter, whereinthe second surgical instrument is configured to communicate the detectedsecond parameter to the first surgical instrument, and wherein the firstsurgical instrument is configured to modify the control command with thefirst parameter detected by the first surgical instrument and the secondparameter detected by the second surgical instrument.

Example 20—The surgical system of Examples 15, 16, 17, 18, or 19,wherein the second surgical instrument comprises a smoke evacuationsystem configured to remove smoke from a surgical site.

While several forms have been illustrated and described, it is not theintention of Applicant to restrict or limit the scope of the appendedclaims to such detail. Numerous modifications, variations, changes,substitutions, combinations, and equivalents to those forms may beimplemented and will occur to those skilled in the art without departingfrom the scope of the present disclosure. Moreover, the structure ofeach element associated with the described forms can be alternativelydescribed as a means for providing the function performed by theelement. Also, where materials are disclosed for certain components,other materials may be used. It is therefore to be understood that theforegoing description and the appended claims are intended to cover allsuch modifications, combinations, and variations as falling within thescope of the disclosed forms. The appended claims are intended to coverall such modifications, variations, changes, substitutions,modifications, and equivalents.

The foregoing detailed description has set forth various forms of thedevices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, and/or examples can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof.Those skilled in the art will recognize that some aspects of the formsdisclosed herein, in whole or in part, can be equivalently implementedin integrated circuits, as one or more computer programs running on oneor more computers (e.g., as one or more programs running on one or morecomputer systems), as one or more programs running on one or moreprocessors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, those skilled inthe art will appreciate that the mechanisms of the subject matterdescribed herein are capable of being distributed as one or more programproducts in a variety of forms, and that an illustrative form of thesubject matter described herein applies regardless of the particulartype of signal bearing medium used to actually carry out thedistribution.

Instructions used to program logic to perform various disclosed aspectscan be stored within a memory in the system, such as dynamic randomaccess memory (DRAM), cache, flash memory, or other storage.Furthermore, the instructions can be distributed via a network or by wayof other computer readable media. Thus a machine-readable medium mayinclude any mechanism for storing or transmitting information in a formreadable by a machine (e.g., a computer), but is not limited to, floppydiskettes, optical disks, compact disc, read-only memory (CD-ROMs), andmagneto-optical disks, read-only memory (ROMs), random access memory(RAM), erasable programmable read-only memory (EPROM), electricallyerasable programmable read-only memory (EEPROM), magnetic or opticalcards, flash memory, or a tangible, machine-readable storage used in thetransmission of information over the Internet via electrical, optical,acoustical or other forms of propagated signals (e.g., carrier waves,infrared signals, digital signals, etc.). Accordingly, thenon-transitory computer-readable medium includes any type of tangiblemachine-readable medium suitable for storing or transmitting electronicinstructions or information in a form readable by a machine (e.g., acomputer).

As used in any aspect herein, the term “control circuit” may refer to,for example, hardwired circuitry, programmable circuitry (e.g., acomputer processor including one or more individual instructionprocessing cores, processing unit, processor, microcontroller,microcontroller unit, controller, digital signal processor (DSP),programmable logic device (PLD), programmable logic array (PLA), orfield programmable gate array (FPGA)), state machine circuitry, firmwarethat stores instructions executed by programmable circuitry, and anycombination thereof. The control circuit may, collectively orindividually, be embodied as circuitry that forms part of a largersystem, for example, an integrated circuit (IC), an application-specificintegrated circuit (ASIC), a system on-chip (SoC), desktop computers,laptop computers, tablet computers, servers, smart phones, etc.Accordingly, as used herein “control circuit” includes, but is notlimited to, electrical circuitry having at least one discrete electricalcircuit, electrical circuitry having at least one integrated circuit,electrical circuitry having at least one application specific integratedcircuit, electrical circuitry forming a general purpose computing deviceconfigured by a computer program (e.g., a general purpose computerconfigured by a computer program which at least partially carries outprocesses and/or devices described herein, or a microprocessorconfigured by a computer program which at least partially carries outprocesses and/or devices described herein), electrical circuitry forminga memory device (e.g., forms of random access memory), and/or electricalcircuitry forming a communications device (e.g., a modem, communicationsswitch, or optical-electrical equipment). Those having skill in the artwill recognize that the subject matter described herein may beimplemented in an analog or digital fashion or some combination thereof.

As used in any aspect herein, the term “logic” may refer to an app,software, firmware and/or circuitry configured to perform any of theaforementioned operations. Software may be embodied as a softwarepackage, code, instructions, instruction sets and/or data recorded onnon-transitory computer readable storage medium. Firmware may beembodied as code, instructions or instruction sets and/or data that arehard-coded (e.g., nonvolatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module”and the like can refer to a computer-related entity, either hardware, acombination of hardware and software, software, or software inexecution.

As used in any aspect herein, an “algorithm” refers to a self-consistentsequence of steps leading to a desired result, where a “step” refers toa manipulation of physical quantities and/or logic states which may,though need not necessarily, take the form of electrical or magneticsignals capable of being stored, transferred, combined, compared, andotherwise manipulated. It is common usage to refer to these signals asbits, values, elements, symbols, characters, terms, numbers, or thelike. These and similar terms may be associated with the appropriatephysical quantities and are merely convenient labels applied to thesequantities and/or states.

A network may include a packet switched network. The communicationdevices may be capable of communicating with each other using a selectedpacket switched network communications protocol. One examplecommunications protocol may include an Ethernet communications protocolwhich may be capable permitting communication using a TransmissionControl Protocol/Internet Protocol (TCP/IP). The Ethernet protocol maycomply or be compatible with the Ethernet standard published by theInstitute of Electrical and Electronics Engineers (IEEE) titled “IEEE802.3 Standard”, published in December, 2008 and/or later versions ofthis standard. Alternatively or additionally, the communication devicesmay be capable of communicating with each other using an X.25communications protocol. The X.25 communications protocol may comply orbe compatible with a standard promulgated by the InternationalTelecommunication Union-Telecommunication Standardization Sector(ITU-T). Alternatively or additionally, the communication devices may becapable of communicating with each other using a frame relaycommunications protocol. The frame relay communications protocol maycomply or be compatible with a standard promulgated by ConsultativeCommittee for International Telegraph and Telephone (CCITT) and/or theAmerican National Standards Institute (ANSI). Alternatively oradditionally, the transceivers may be capable of communicating with eachother using an Asynchronous Transfer Mode (ATM) communications protocol.The ATM communications protocol may comply or be compatible with an ATMstandard published by the ATM Forum titled “ATM-MPLS NetworkInterworking 2.0” published August 2001, and/or later versions of thisstandard. Of course, different and/or after-developedconnection-oriented network communication protocols are equallycontemplated herein.

Unless specifically stated otherwise as apparent from the foregoingdisclosure, it is appreciated that, throughout the foregoing disclosure,discussions using terms such as “processing,” “computing,”“calculating,” “determining,” “displaying,” or the like, refer to theaction and processes of a computer system, or similar electroniccomputing device, that manipulates and transforms data represented asphysical (electronic) quantities within the computer system's registersand memories into other data similarly represented as physicalquantities within the computer system memories or registers or othersuch information storage, transmission or display devices.

One or more components may be referred to herein as “configured to,”“configurable to,” “operable/operative to,” “adapted/adaptable,” “ableto,” “conformable/conformed to,” etc. Those skilled in the art willrecognize that “configured to” can generally encompass active-statecomponents and/or inactive-state components and/or standby-statecomponents, unless context requires otherwise.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Those skilled in the art will recognize that, in general, terms usedherein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitationis explicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that typically a disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms unless context dictates otherwise. For example, the phrase “Aor B” will be typically understood to include the possibilities of “A”or “B” or “A and B.”

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flow diagrams arepresented in a sequence(s), it should be understood that the variousoperations may be performed in other orders than those which areillustrated, or may be performed concurrently. Examples of suchalternate orderings may include overlapping, interleaved, interrupted,reordered, incremental, preparatory, supplemental, simultaneous,reverse, or other variant orderings, unless context dictates otherwise.Furthermore, terms like “responsive to,” “related to,” or otherpast-tense adjectives are generally not intended to exclude suchvariants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,”“an exemplification,” “one exemplification,” and the like means that aparticular feature, structure, or characteristic described in connectionwith the aspect is included in at least one aspect. Thus, appearances ofthe phrases “in one aspect,” “in an aspect,” “in an exemplification,”and “in one exemplification” in various places throughout thespecification are not necessarily all referring to the same aspect.Furthermore, the particular features, structures or characteristics maybe combined in any suitable manner in one or more aspects.

In this specification, unless otherwise indicated, terms “about” or“approximately” as used in the present disclosure, unless otherwisespecified, means an acceptable error for a particular value asdetermined by one of ordinary skill in the art, which depends in part onhow the value is measured or determined. In certain embodiments, theterm “about” or “approximately” means within 1, 2, 3, or 4 standarddeviations. In certain embodiments, the term “about” or “approximately”means within 50%, 20%, 15%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%,0.5%, or 0.05% of a given value or range.

In this specification, unless otherwise indicated, all numericalparameters are to be understood as being prefaced and modified in allinstances by the term “about,” in which the numerical parameters possessthe inherent variability characteristic of the underlying measurementtechniques used to determine the numerical value of the parameter. Atthe very least, and not as an attempt to limit the application of thedoctrine of equivalents to the scope of the claims, each numericalparameter described herein should at least be construed in light of thenumber of reported significant digits and by applying ordinary roundingtechniques.

Any numerical range recited herein includes all sub-ranges subsumedwithin the recited range. For example, a range of “1 to 10” includes allsub-ranges between (and including) the recited minimum value of 1 andthe recited maximum value of 10, that is, having a minimum value equalto or greater than 1 and a maximum value equal to or less than 10. Also,all ranges recited herein are inclusive of the end points of the recitedranges. For example, a range of “1 to 10” includes the end points 1 and10. Any maximum numerical limitation recited in this specification isintended to include all lower numerical limitations subsumed therein,and any minimum numerical limitation recited in this specification isintended to include all higher numerical limitations subsumed therein.Accordingly, Applicant reserves the right to amend this specification,including the claims, to expressly recite any sub-range subsumed withinthe ranges expressly recited. All such ranges are inherently describedin this specification.

Any patent application, patent, non-patent publication, or otherdisclosure material referred to in this specification and/or listed inany Application Data Sheet is incorporated by reference herein, to theextent that the incorporated materials is not inconsistent herewith. Assuch, and to the extent necessary, the disclosure as explicitly setforth herein supersedes any conflicting material incorporated herein byreference. Any material, or portion thereof, that is said to beincorporated by reference herein, but which conflicts with existingdefinitions, statements, or other disclosure material set forth hereinwill only be incorporated to the extent that no conflict arises betweenthat incorporated material and the existing disclosure material.

In summary, numerous benefits have been described which result fromemploying the concepts described herein. The foregoing description ofthe one or more forms has been presented for purposes of illustrationand description. It is not intended to be exhaustive or limiting to theprecise form disclosed. Modifications or variations are possible inlight of the above teachings. The one or more forms were chosen anddescribed in order to illustrate principles and practical application tothereby enable one of ordinary skill in the art to utilize the variousforms and with various modifications as are suited to the particular usecontemplated. It is intended that the claims submitted herewith definethe overall scope.

What is claimed is:
 1. A surgical system, comprising: a surgicalinstrument, comprising: an end effector, comprising: a first jaw; and asecond jaw, wherein at least one of the first jaw and the second jaw ismoved with respect to one another between an open position and a closedposition, wherein tissue is configured to be positioned between thefirst jaw and the second jaw; a generator configured to supply power tothe end effector; and a processor configured to run a control program tooperate the surgical system, wherein the processor is configured to:detect a first parameter of the surgical system; detect at least oneuser input; and modify the control program in response to the detectedfirst parameter and the at least one user input.
 2. The surgical systemof claim 1, wherein the control program is configured to control a powerlevel of the generator.
 3. The surgical system of claim 1, wherein thecontrol program is configured to control a motor, wherein the motor isconfigured to cause the end effector to move between the openconfiguration and the closed configuration.
 4. The surgical system ofclaim 3, wherein the control program is configured to control the motorthrough motor control parameters, and wherein the control program isconfigured to adjust the motor control parameters in response to thedetected first parameter and the detected user input.
 5. The surgicalsystem of claim 1, wherein the first parameter comprises an instrumentactuation parameter.
 6. The surgical system of claim 1, wherein thefirst parameter comprises a generator operating parameter.
 7. Thesurgical system of claim 1, wherein the first parameter comprises astatus of the end effector.
 8. The surgical system of claim 7, whereinthe first parameter indicates whether the end effector is in the openconfiguration or the closed configuration.
 9. The surgical system ofclaim 7, wherein the first parameter indicates whether the tissue ispositioned between the first jaw and the second jaw.
 10. The surgicalsystem of claim 1, wherein the surgical instrument is in operationalcontrol, and wherein the generator is a slave control system by default.11. The surgical system of claim 10, wherein the control program isconfigured to cause the generator to be in operational control and thesurgical instrument to be the slave control system in response to thedetected first parameter and the detected user input.
 12. The surgicalsystem of claim 1, wherein the first parameter comprises a combinationof two measures.
 13. The surgical system of claim 1, wherein thesurgical system further comprises a trigger configured to receive theuser input, wherein the processor is configured to interpret multipleuser inputs received by the trigger, wherein each user input comprises adifferent meaning based on situational usage.
 14. A surgical system,comprising: a surgical instrument; a generator configured to supplypower to the surgical instrument; and a processor configured to run acontrol program to operate the surgical system, wherein the processor isconfigured to: detect a status of the surgical instrument; detect atleast one user input; and adapt the control program in response to thedetected status of the surgical instrument and the at least one userinput.
 15. The surgical system of claim 14, wherein the surgicalinstrument comprises an end effector, wherein the end effector isconfigurable in an open configuration and a closed configuration, andwherein the status of the surgical instrument corresponds to whether theend effector is in the open configuration or the closed configuration.16. The surgical system of claim 14, wherein the surgical instrumentcomprises an end effector, wherein the end effector is configurable inan open configuration and a closed configuration, and wherein the statusof the surgical instrument corresponds to whether patient tissue ispositioned between the first jaw and the second jaw.
 17. The surgicalsystem of claim 14, wherein the surgical system further comprises aninput member configured to receive the user input, wherein the processoris configured to interpret multiple user inputs received by the inputmember, wherein each received user input comprises a different meaningbased on situational usage of the surgical system.
 18. A surgicalsystem, comprising: a surgical instrument, comprising: an end effector,comprising: a first jaw; and a second jaw, wherein at least one of thefirst jaw and the second jaw is moved with respect to one anotherbetween an open position and a closed position, wherein tissue isconfigured to be positioned between the first jaw and the second jaw; agenerator configured to supply power to the end effector; and aprocessor configured to run a control program to operate the surgicalsystem, wherein the processor is configured to: detect a first parameterof the surgical instrument; detect a second parameter of the generator;detect at least one user input; and modify the control program inresponse to the detected first parameter, the detected second parameter,and the at least one user input.
 19. The surgical system of claim 18,wherein the first parameter of the surgical instrument corresponds towhether the end effector is in the open configuration or the closedconfiguration and whether patient tissue is positioned between the firstjaw and the second jaw.
 20. The surgical system of claim 18, wherein thesurgical instrument further comprises an input member configured toreceive the user input, wherein the processor is configured to interpretmultiple user inputs received by the input member, wherein each receiveduser input comprises a different meaning based on situational usage ofthe surgical instrument within the surgical system.